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BEAUTY SHOP / SALON QUOTE
Applicant's Name:
Mailing Address:
City  State     Zip
Phone:      Fax: 		PROPOSED EFFECTIVE DATE:
From     To

Email:

Number Full-Time Employees     Number Part-Time Employees

Years in Business:    Gross Annual Sales: $       Gross Annual Payroll: $

Describe the Nature of Business:

 CURRENT INSURANCE INFORMATION
 Company Name (not agency):   Policy Expiration Date:    Amount insured for: $
 Years insured:   Premium Amount: $    Term:      If Other:
  If less than 3 years, prior company:

 Prior Losses/Dates (last 3 years)
 Include Description, Date, Amount
 COVERAGE
 Building Limit: $      Contents Replacement Value:
 Liability Limit (Occurrence/Aggregate):       Property Deductible:
 
Type of Coverage: 
 CONSTRUCTION
 Exterior:    Age of building:
 Square footage of your business area?    Square footage of the entire building?
 Roof:     Age of roof:     
 Stories in building:     Updated Heating or  Plumbing? Yes     No

 Within 1000 feet of a fire hydrant?
 Within 5 miles of a fire station?
 Central station Burglar Alarm?
 Automatic sprinkler system covering 100% of your premises?

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