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Business Insurance:
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For Your Convenience
We Gladly Accept:
Local Phone:
480-507-1893
Fax:
480-305-5369
Website Design by:
Insurance-Web-Sales © 2006
Please Call Us for a FREE Arizona Insurance Phone Quote or fill out the simple form below for an online quote!
Our EASY Quote Form Below:
Restaurant "Quick Quote" Application
Complete this 2 minute form, and we will show you how much
we can save you on your Restaurant Insurance Plan!
Your Name (First AND Last):
Restaurant Name:
Contact Phone Number:
Your E-Mail Address:
Confirm E-mail Address Again:
Location City, State and Zip Code (Must be in New York):
Restaurant Type:
Choose One
Fine Dining
Casual
Pizza (Delivery)
Pizza (No Delivery)
Fast Food
Bar / Tavern (Food)
Bar / Tavern (No Food)
Nightclub (Live Entertainment)
Nightclub (No Entertainment)
Gentlemen's Club
Other
Current Insurance Company:
Renewal Date:
Current Cost:
Any Claims in the Last 3 Years?
Choose One
Yes
No
Liquor Liability Included in Current Coverage?
Choose One
Yes
No
Building Coverage:
Choose One
Own the Building
Do NOT Own the Building
Age of Building:
Business Property Amount:
Ansul Type:
Deductible:
Catering?
Choose One
Yes
No
Patio?
Choose One
Yes
No
Live Music?
Choose One
Yes
No
DJ?
Choose One
Yes
No
Total Square Footage:
Public Access Sq. Ft.:
Approximate Gross Sales:
Food Sale %:
Alcohol Sale %:
Number of Employees: