Restaurant/Pizzeria/Luncheonette Quote
Insured's Name:
Insured's Legal Name:
   
Type of Operation:
Family Style
Luncheonette
Pizzeria		 Diner
Fine Dining 		Fast Food
Franchise
   
Address:
 
City:
State:
   Zip: 
   
Email Address:
Phone Number:
   
Organization Type:
Sole Proprietor
Partnership 		     Corp
LLC
   
# of F/T Employees:
# of P/T Employees:
Estimated Annual Payroll: $
Annual Gross Receipts: $
   
Any outside catering? Yes No
     If yes, what percentage of gross receipts? %
   
Number of years in business at this location:
Number of years experience in this business:
   
Federal Tax I.D. # or SS#: (required)
   
Is there live entertainment? Yes No
     If yes, describe:
   
Ansul (Cooking Hood) System Type:
   
Liquor sold and served on Premises? Yes No
     If yes, sales breakdown: % Food and % liquor
Is there a Dance Floor? Yes No