T5 Insurance Commercial Insurance Intake FormAgent Name(Required) First Last Legal Company NameMain Contact for CompanyCompany AddressNumber of LocationsPhone Number - Personal & BusinessEmailWhat type of business is this?LLCPartnershipSole ProprietorOtherWhen did the business start? MM slash DD slash YYYY How many years of experience?Please enter a number less than or equal to 300.Tax ID #Annual Revenue GrossWhere does the revenue come from? One source?How many employees do you have - (Part-Time & Full-Time)Any subcontractors used? If YES - what is the annual cost for subs and materials?What type of insurance are you looking for?Do you own any buildings? If so, how many? Addresses?What is the total value of business property owned by the business?What is the square footage of the space used for business?Do you have physical/equipment to insure?How many autos will be insuring on a commercial policy?Do you have/want an umbrella policy?Who is your current provider? How long have you been with them?What has you looking elsewhere?Has the business filed any claims in the last 5 years or less? If YES, how many?What is your time frame? How quickly do you need insurance? Do you have a renewal coming soon?Any other additional information you want to share with us?How did you hear about us?If Commercial Auto, do you have attached Equipment?Additional comments for agent.
