Business Quote Form First Name Last Name Business Name Business Address City State KS MO Zip Code Phone Number Business Information Year Business Started Years Experience Business Type IndividualCorporationPartnership Number of Partners LocationResidenceCommercial Building Sq. Foot Occupied Sq. Foot of Building Connected Business in Building If Contractor Use Sub-ContractorsYN If yes require Cert of Ins? % of Gross Roofing % of Gross Sub'd Out % Commercial Business % Residential Business % Exterior % Interior Detailed Description of Business # of FT ees #of PT ees Gross Annual Sales Amount of Equipment/Inventory Coverage Needed Any Prior Coverage Prior Carrier Cost Loss History (5 years) Date of Loss Amount Paid ClosedYN Commercial Building Information(If not in your residence) Construction TypeFrameMasonry/BrickMasonry VeneerAluminum SidingPlastic Vinyl SidingLogConcrete Block Year Built Purchase Date Purchase Price/Loan Amount Number of Stories 1 1.5 22.53 Bi-level Tri-level Split-level BasementCrawlSlabFullNone Finished Sq. Feet WalkoutYN Fire Department Distance to Hydrant (ft) Distance to Fire Station (Miles) Wiring Update ?YNPartialComplete Year Updated Circuit Breakers or Fuses? Amps100+-100 AluminumYN Knob & TubeYN Heating Update ?YNPartialComplete Year Updated Heat TypeGasElectricSolarBase Board Plumbing Update ?YNPartialComplete Year Updated Roof Update ?YNPartialComplete Year Updated Roof TypeCompFilber/concreteSlateWood TileMetalTar & Gravel SprinklerYN Alarm SystemYN