Commercial Insurance Annual Review Update/Confirm Contact InformationName* First Last Business Name*Phone*Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Tax ID | Federal IDBusiness Auto Insurance Review - In The Past 9-12 MonthsHas there been a change of drivers on your policy?NoYesHas there been a change of vehicles listed on your policy?NoYesHas there been a change in the radius of operations?NoYesHave any insured vehicles been customized or altered?NoYesHave you paid off a vehicle loan?NoYesHave you discussed Comprehensive Coverage with your Agent?NoYesHave you discussed Collision Coverage with your Agent?NoYesHave you considered raising you Liability Limits?NoYesWould you like and Advisor to contact you?NoYesBusiness Owners Insurance Review - In The Past 9-12 MonthsHas there been a change in operations (or added additional operations)?YesNoHave you done work outside of NC?NoYesHave your sales increased?NoYesHas your payroll increased?NoYesHave you added any new locations? Removed Locations?NoYesHave you added any new equipment?NoYesHave you increased Business Personal Property | Inventory?NoYesDo you have a central station security and/or fire alarm systemYesNoHave you paid off or refinanced any loans?YesNoHave you made any significant home improvements (additions, updates to plumbing, HVAC, roof, electrical)YesNoFloods are not a covered cause of loss, would you like more informationYesNoWorkers Compensation Insurance Review - In The Past 9-12 MonthsShould Owner/Officers Be Included or Excluded From Coverage?ExcludedIncludedHave you added any additional employment job types (i.e. new operations)?NoYesHave you added any new locations? Removed Locations?NoYesAdditional Questions ShareFacebookTwitterLinkedInGoogleMorePinterestRedditEmailPrint
