Hospitality Insurance Providers

Applications

* REQUIRED

Corporation/Building Information
*Name and DBA
*Insured
*Address
*City
*State
*Zip
E-mail Address	name@address.com
*Phone Number (area code)	(xxx) xxx-xxxx
Best time to call
Any comments to add?
Effective Date	MM/DD/YYYY
Occupancy
Construction
Building Age	years
Square Feet	sq.ft.
Updates to Building
Wiring	sq.ft.
Type of Wiring
Plumbing
Roof
Type of Area
Distance to Fire Department	Miles
Distance to Fire Hydrant	Ft.
Check all that apply	Sprinklers Fire Alarm Central Station Alarm
Name of Alarm Company
Limits
Building #1
Deductible
Loss of Earnings
Contents #1
Deductible
ACV
RC
Previous Carrier
Expiring Rate/Terms/Conditions
Declined or Non-Renewed
If so, why...
3 Year Loss History If Any
Mortgage Name & Address
Name
Address
City
State
Zip
Remarks

Quotes are based on information provided, which will be verified before acceptance.
Acceptance is based upon your continuing qualification. Individual savings may vary.
Additional information may be required to complete accurate quote.
You will NOT automatically be covered by insurance by simply submitting a request for insurance quote or applying online.
Your agent will let you know, if accepted, when your insurance coverage begins.