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BUSINESS QUESTIONNAIRE
- For your
convenience Tashjian Insurance Agency, Inc. keeps their fax
lines open at all times. Please print out this sheet and fax it to
626.357.5037.
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:
- Bussiness Property Coverage:
-
- Policy Deductible:
$250.00 $1000
0 $500.00
$2500
-
- Liability Coverage Limits:
$300,000
$500,000
$1,000,000
$2,000,000
BRIEF DESCRIPTION/COMMENTS:
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