Business Information Update "*" indicates required fields Full Name:* First Last Business Legal Name (and DBA, if applicable): Phone Number:*Email Address:* Mailing/Correspondence Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are there any significant changes in your business operation since we last spoke? (Merger/Acquisition, New lines of business, new categories of operation, etc.)How many W-2 employees does your team currently have? What is your projected total W-2 payroll for the upcoming 12 months? What is your projected gross revenue for the upcoming 12 months? What is your projected total paid to subcontractors or 1099 team members for the upcoming 12 months? (if applicable) If you have acquired any new property, added locations, or made other changes that effect your insurance needs, please detail them here.Do we need to add any additional insured's to your policy? (Bank, landlord, new contracts, etc) Is there anything else that we need to know now to make sure your insurance program is exactly what you need?You may upload up to 3 files to us, if necessary. Drop files here or Select files Max. file size: 500 MB, Max. files: 3.
