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Personal Auto Questionary
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Open Cargo Insurance Application
Workers' Compensation Insurance Questionnaire
Commercial Liability & Property Insurance Questionnaire
HomeOwner Insurance Quote Rquest
School Questionnaire
Apartment/Condo Questionnaire
Restaurant Questionnaire

FORBUSINESSINSURANCE.COM
2640 E. Garvey Ave South, #207 W. Covina, Ca 91791
Tel: 626-653-0708 Fax: 626-653-0707

School Questionnaire

NAME OF SCHOOL:
BUSINESS ADDRESS:
NATURE OF BUSINESS:CORPORATION    INDIVIDUAL    PARTNER    
YEAR IN BUSINESS: , PRIOR EXPERIENCE:
FEDERAL TAX ID NUMBER:
Contact Person: *
Phone: *
HOURS FROM:AM  TO PM.
HOW MANY DAYS DO YOU OPEN PER WEEK? 
NUMBER OF STUDENTS: 
AREA? 
ARE FOOD PROVIDED ? YES    NO    
ANY "KONG-FU" OR SWIMMING CLASSS? YES    NO    
TOTAL ESTIMATED ANNUAL TUITION INCOME :$ 
ANY FIELD TRIPS PROVIDED? YES    NO    
TOTAL NUMBER OF EMPLOYEES AND TEACHERS? 
AGE OF BUILDING: 
TYPE OF BUILDING:MASONRY    STUCCO     OR OTHER
HOW MANY FLOORS? 
ANY SPRINKLERS IN THE BUILDING? YES    NO    
REPLACEMENT VALUE OF THE BUILDING:$ 
only if you request to insure the building
ARE YOU REQUIRED BY THE LANDLORD TO PROVIDE INSURANCE? IF YES,
PLEASE PROVIDE US WITH THE NAME AND ADDRESS OF YOUR LANDLORD:
AMOUNT OF YOUR BUSINESS PERSONAL PROPERTY REQUESTED FOR INSURANCE:$ 
(That includes your school equipment,furniture,and stock)
ANY CENTRAL ALARM SYSTEM FOR YOUR LOCATION? YES    NO    
YOUR RIGHT NEIGHBOR IS A? 
LEFT? 
REAR? 
DO YOU HAVE ANY PRIOR INSURANCE? YES    NO    
IF YES,PLEASE ANSWER THE FOLLOWING:
PRIOR INSURANCE NAME: 
POLICY #: 
EXPIRATION DATE: 
EXP. PREMIUM:$ 
DID YOU HAVE ANY CLAIM OR LOST? YES    NO    
IF YES, PLEASE PROVIDE THE DETAIL:
DATE OF LOST: 
AMOUNT PAID$: 
REASON OF LOST: 
DETAIL DESCRIPTION OF YOUR BUSINESS OPERATION
 
        


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