Online Business Insurance Quote

Company Name*

Address*

Street Address Address Line 2 City State ZIP Code

Is your mailing address the same as your business address?

Yes
No

Mailing Address

Street Address Address Line 2 City State ZIP Code

Business Start Year*

The year this business was established.

How many years of experience do you have in this industry?*

This refers to the total number of years of work experience in the business regardless of whether you own the business.

Projected annual revenue(next 12 months)

Website (Optional)

What form of business entity do you have?*

What's your industry type?

Primary Contact Info

With this information provided, a CoverWallet account will be created for you.

Name*

First Last

Email*

Phone*

Employees Details

Tell us about the awesome people you work with

Total Number of Owners (actively involved in business operations)

Number of Full-Time Employees (not including owners)

Number of Part-Time Employees (not including owners)

Projected Employee Payroll(not including owners) for next 12 months

Building Details

for your location

Type of Building

How is the building constructed?

Are there automatic sprinklers?

Is there a fire alarm system?

Do you have a central burglar alarm system?

How many stories does the building have?

What is the square footage of your business?

Do you need to insure the building?

When was the building constructed (year)?

What is the replacement cost of your business personal property?

Business Owner's Policy

Have you had any BOP or General Liability claims or losses in the last 5 years?

Yes
No

Please complete the following questions for each BOP or General Liability claim or loss you have experienced in the past 5 years

Date of Occurrence (MM/YYYY)

How much has been paid for this claim or loss?

Additional Info

Do you want coverage for Certified Acts of Terrorism?

Yes
No

Does your landlord want to be listed as an additional insured on your policy?

Do any of your clients want to be listed as an additional insured on your policy?

When would you like your policy to start?

Is there anything special we should know about your business or the specific coverage you need? For example, minimum insurance requirements or claims you've made in the last 3 years.