BUSINESS QUESTIONNAIRE

Tashjian Insurance Agency, Inc. is committed to providing you with the best  in customer service. By filling out this questionnaire you will have a custom  quote prepared for you the next business day. For your convenience Tashjian  Insurance Agency, Inc. keeps their fax lines open at all times in case you  prefer to print out this form and fax it instead of submitting it online.

Contact Information:

 Contact Name:  

 Business Name:  

 Contact Phone: E-Mail Address:  

 Street Address:

 City: State: Zip Code:

 

Location Information:

Year Built: Glass, Linear Feet:

Square Feet: Exterior Sign Value:

CLICK ALL THAT APPLY:

Construction Type: Wood Frame Masonry Steel Frame

 

Security Features: Central Alarm Surveillance Cameras Security Gates

 

Fire Safety Features: Fire Sprinklers Fire Alarm Fire Extinguishers

 

# Full Time Employees:  

# Part Time Employees Total Payroll:

Gross Annual Receipts: Years In Business:

Coverage Information:

Building Coverage:  

Business Property Coverage:

 

Policy Deductible: $250 $500 $1,000 $2,500

 

Liability Coverage Limits: $300,000 $500,000 $1,000,000 $2,000,000

BRIEF DESCRIPTION/COMMENTS: