Commercial Insurance

 

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Note: Only available to residents of New Brunswick

Company Name: Operating as:  
Owner’s Name:    
Phone Number:    

 

Physical Address  
Address:    
City:  
Province:
Postal Code:      

 

Mailing Address (if different from above):  
Address:    
City:  
Province:
Postal Code:      

 

Business Information  
Year that building was built:      
Construction of Building:

Does the building have a sprinkler system:

 Yes   No
Alarm systems:
If yes, is alarm: 
Type of heating:




Area occupied (sq. feet):
Are you the only tenant? Yes No
Is there a fire hydrant within 500 ft. (150 meters): Yes No
Is there a fire hall within 7km: Yes No
Has insurance coverage ever been denied or cancelled: Yes No
What is your business type:
How many years have you been in business:
How many claims has the business had in the last 3 years?
Cause of loss(es), if applicable:   (ex: fire, theft, etc.)
   

 

Liability Information  
What are your annual gross receipts? $   
How much is your annual payroll? $    
Commercial General Liability Coverage $
Liability deductible:

 

Property Coverage Limits  
Building $   
Equipment $   
Stock $     
Property deductible:
Briefly describe your business’s operations:    

 

I give my consent for Kent and White Insurance to use this information for the purpose of obtaining an accurate insurance quote. This information will not be used, or shared with any other parties, for any reason other than obtaining an accurate insurance quote.
I accept
I do not accept

 

 





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