Business Insurance
You will need to give us all the information below to receive an accurate quote.
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Business Location
Address:
City:
State:
ZIP:
Phone:
Fax (optional):
E-Mail:
Area (square feet):
Year Built
If over 30 years old, was the following updated? If "YES", when?
Roof:
No
Yes Date:
Wiring:
No
Yes Date:
Heating:
No
Yes Date:
Plumbing:
No
Yes Date:
Number of Stories:
Building Value (if you own it):
$
Business Contents Value:
$
Gross Anual Receipts:
$
Annual Payroll:
$
What is the limit of
Required Liability:
$
Deductible:
$500
$1,000
$2,000
$2,500
Other
Construction Type
Exterial Walls:
Wood, stucco, or brick veneer
Masonary (brick, concrete block, stone)
Fireproofed walls
Does the building
have sprinklers?
No
Yes
Is there a fire/burglar alarm?
No
Yes
If yes, what type?
Central station
Police Department
Local
Other
Current Insurer
Insurer:
Policy Number:
Expiration Date:
J. Stine Agency, Inc.
65 First Avenue ♦ PO Box 265
Atlantic Highlands, New Jersey 07716
Phone: 732.291.8773 ♦ Fax: 732.291.1846
©J. Stine Agency, Inc.
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