Business Insurance Quote

Information We need to Start a Quote- Please email Support@karstensfinancial.com


Business Name:


 

DBA:


 

FEIN:


 

Radius and Territory    of Operations:


 

Hours of Operations:


 

Type of Business Registeration:


__C-Corp

__S-Corp

__Partnership

__LLC

__Individual

__Other______________

 

Contact Name:


 

Contact Phone Number:


 

Contact E-Mail:


 

Location Information:

2629-31 N Dayton St

Chicago IL 60614


Address_______________________

City____________________________

State__________________________

County_________________________

Zip Code________________________

Phone Number ( )____________

Fax Number ( )______________

Web Site Address www.____________

 

Is the mailing address the same as above?


____Yes _____No

 

If not, please provide.


Address________________________

City____________________________

State___________________________

Zip Code________________________

Phone Number ( )____________

Fax Number ( )______________

 

The year the business started.


 

Number of years of experience in the business industry.


 

Complete Description of Operations.


 

Annual Sales:


 

Do you deliver products?


_____Yes ___ __No

 

If yes, please explain.


 

Does your business require special regulations, licenses,   state or government intervention?


_____Yes ___ __No

 

If yes, please explain.


 

Is there current coverage in place?


___ __Yes _____No

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