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Personal Auto Questionary
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Restaurant Questionnaire

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

Restaurant Questionnaire

NAME OF THE ENTITY:
MAILING ADDRESS:
NATURE OF BUSINESS:CORPORATION    INDIVIDUAL    PARTNER    
YEAR IN BUSINESS:,PRIOR EXPERIENCE:
FEDERAL TAX ID NUMBER:
Contact Person: *
Phone: *
HOURS FROM:AM  TOPM.
HOW MANY DAYS DO YOU OPEN PER WEEK? 
CAPACITY OF YOUR RESTURANT: 
AREA? PUBLIC AREA:,KITCHEN:
HOW OFTEN DO YOU CHANGE THE FILTERS? 
THE BRAND NAME OF THE AUTOMETIC EXTINGUISHING SYSTEM
ANY "HAPPY HOURS" WITH LIQUOR? YES    NO    
ANY ENTERTAINMENT? YES    NO    
TOTAL ESTIMATED ANNUAL SALE FOOD  $
LIQUORE $
TOTAL NUMBER OF EMPLOYEES: 
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 restaurant 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
PROPERTY LOCATION ADDRESS: *
 
        


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