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Bar & Tavern/Nightclub/Restaurant Quote Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Company Information
Company Name
Required
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
Primary Phone Number
Required
Alternate Phone Number
Optional
E-Mail Address
Required
Company Owner
First Name
Required
Last Name
Required
Nature of Business
Optional
Number of Owners
Optional
Gross Annual Sales
Optional
Number of Employees
Optional
Annual Employee Payroll
Optional
Square Footage of Location
Optional
Additional Information
Prior Insurance
Optional
Length of Coverage (Months and Years)
Optional
Number of Additional Insureds Needed
Optional
Venue Information
Annual Food Sales
Required
Annual Liquor Sales
Required
# of Oven(s)
Required
Fuel Source
Required
# of Fryer(s)
Required
Fuel Source
Optional
# of Grill(s)
Required
Fuel Source
Optional
# of Range Top(s)
Required
Fuel Source
Optional
# of Grill(s)
Required
Fuel Source
Optional
# of Broiler(s)
Required
Fuel Source
Optional
Other cooking units not listed and how many?
Optional
Is there an automatic extinguishing system?
Required
Do you have fire extinguishers?
Required
Do you have smoke detectors?
Required
Seating Capacity
Required
Any entertainment?
Required
If "Yes", what type?
Optional
Dance floor available?
Required
If "Yes", whats is the square footage?
Optional
If "Yes", are railings installed?
Optional
Coverage Information
General Liability Limit
Required
Liquor Liability Limit
Required
Building Limit
Optional
Contents Limit
Optional
How did you hear about us?
Required
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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