Restaurant Quote




Business Name

Business Entity

Owners Name(s)

Contact Person

Property Address

City

State

ZIP Code

Mailing Address if different

City

State

ZIP Code

Phone
- -

( ### )        ###            ####

Fax
- -

( ### )        ###            ####

E-mail

Web Site





SECTION BREAK

Square Footage of Building Occupied

Square Footage of Customer Area

Seating Capacity

Number of Stories

Building Construction Type

Roof Type

Year building built

Building Has Automated Ceiling Sprinklers?

Smoke Detectors, Fire Extinguishers, Deadbolts on all Doors?
 Yes No

Parking For Your Customers Only?

If Yes, Number of Parking Spaces You Control

Type of Restaurant

Number of Employees

Payroll of Employees

Total Annual Gross Receipts

Total Annual Alcohol Receipts

Years of Management Experience

Years You Have Owned This Business

Ansul 300 System Used?

Ansul Cleaned Professionally?

Cleaned How Often

Catering Away From Premises?

If So, What % of Total Receipts

Central Station Alarm?

Is There Entertainment?

Describe Entertainment

Live Music?

Dance Floor Size (if applicable)

Bouncers, Doormen, ID Checkers, Armed Guards, Security Guards?

If Yes, Number of Each

Are They Employed By You or Hired by an agency

Number of Video Games (Pool Tables)

Number of Video Games (Darts)

Number of Video Games (Other)

Number of Bartenders

Building Coverage Amount if Owned

Contents Coverage Amount

Do You Currently Have Insurance?

Name of Company

Premium

Expiration Date or Renewal Date
[date* date-662 id:datepicker]

Losses in Last three Years (Please Describe and Loss Amount)

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