|
Important
Note:
This
document is made available to you for your convenience. This document is
only a quote application and does not pretend to cover any of the of the
terms and exclusions of the policy herein presented. This document is not
your policy and does not modify or extend the cover of this policy. the
insurance company, emitter of the quote/policy is subjected to all the
exclusions and terms of the policy. If there are any discrepancy between
this description and the quote or policy, the quote or policy will
prevail. Remember, this is just a quote form.
Please note that due to technical or natural events beyond our control,
like weather, we may not receive your quote. Please confirm that your
application has been received by calling to our toll free number
1-800-981-6545, Monday trough Friday from 8:30 am to 5:00 PM.
We
are going to process your application in our agency labor hour's: Monday
through Friday from 8:30 AM to 5:00 PM, except holydays.
It’s
our honor to serve you,
Nehemías
Toro Insurance Agent.
Fill in this information
*Required information
|
|
|
Business Name*
|
|
|
Physical Address of
Business*
|
|
|
City and Zip Code of
Business
|
|
Postal Address of Business
Same as Physical Address
? Yes
|
|
City and Zip Code of Postal
Address
|
|
Business Description*
Ex. What your
business does?, Field or type of industry
|
|
Contact Person Name*
Person that we are
going to contact to inform about the Quote results
|
|
|
Phones for contact person (please provide one at least)
|
Main Phone Number
Please include
extension number if needed
|
Area Code:
Number:
|
|
Extension:
|
Alternative Phone Number
Please include
extension number if needed
|
Area Code:
Number:
|
|
Extension:
|
|
Fax Number
|
Area Code:
Number:
|
|
E-Mail
|
|
|
|
Structure's Number of
Floors*
|
|
|
Is the Structure a rented
one?*
|
Yes
No
|
|
Does the Structure has
limited access?*
|
Yes
No
|
|
Which covers you want to
apply for?*
|
Business's Structure
Business's Content
Money Theft
Vehicles
Umbrella (Press
here for more Information)
|
What type of Construction
the Structure has?*
Optional if the structure is a rented one
|
Other:
|
Structure Limit
What is the
Structure's amount of insurance you want?
|
|
Content Limit
What is the Content's amount
of insurance you want?
|
|
|
Public Liability: (This cover is a must in a Commercial Package)
|
|
What is the insurance limit
you want?*
|
|
Occurrence
What is the insurance
amount per event that you want?
|
|
Aggregate
What is the yearly total
insurance amount per event that you want?
|
|
What is the square feet
area of the Office Structure?*
In case you have are insuring a structure that has a mixed construction
type, How much of that structure has Concrete and how much of the other
material?
|
|
Concrete:
|
|
|
Wood/Other:
|
|
|
What is the amount of total Annual
Sales?*
|
|
|
What is the Total Payroll?*
|
|
|
Money Theft:
|
|
Basic Limit
|
|
|
if your cash flow shows an
irregular pattern during the year, show us the monthly cash flow per month
of the year
|
|
|
Do you want to insure any
commercial vehicles?*
|
Yes No
|
|
|
|
