Restaurant Insurance Request Name * First Name Last Name Business Name * Enter the legal name of your restaurant. Email * Phone * (###) ### #### Type of Restaurant * e.g., dine-in, take-out, fast food, fine dining, bar & grill. Square Footage of Location: * Approximate size of your restaurant in square feet. Years in Business: * How long has your restaurant been in operation? Number of Employees: * Include full-time and part-time staff. Annual Revenue: * Approximate gross revenue for the past year. Liquor Sales: * Yes No If yes, what percentage of total sales come from alcohol? * Do you currently have insurance? If yes, please list current coverage and carrier * Claims History: Have you had any insurance claims in the last 5 years? If yes, please provide details. Additional Coverage Needs: e.g., workers’ compensation, food spoilage, equipment breakdown, delivery coverage. Preferred Contact Method: * Phone Email Text Anything else we should know about your restaurant? Please include any special circumstances or unique aspects of your business. Thank you!
