Bars & Clubs

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    Louisiana • Mississippi • Florida

    Business Info

    Business Name:

    Your Name:

    Address:

    Phone Number:

    E-mail:

    Current Carrier:

    Building Coverage Amount:

    Content Coverage Amount:

    Number of Owners:

    Years in Business:

    Had a loss in the last 3 years?

    YesNo

    Requesting property coverage?

    YesNo

    Limits of Liability:

    Property Info

    Alarm System?

    YesNo

    Square Footage:

    Age of Building:

    Building Construction Type:

    Roof Type:

    Video Game Devices:

    YesNo  

    Pool Tables: YesNo

    Qty/Type:

    Hours of Operation:

    Estimated Food Sales:

    Estimated Liquor Sales:

    Business Income Amount:

    Current Policy's Expiration:

    Comments:

    Your company information will be used for insurance quoting only and not sold for any other purpose. Thank you for letting us quote your insurance needs.