T5 Insurance Commercial Insurance Intake FormThank you for reaching out to T5 Insurance for your commercial insurance needs. Please complete the quote form to the best of your ability. If you're unsure about any answers, no problem — our team will follow up with a quick call to review the details and ensure we have everything we need to get started on your quote.Your First & Last Name(Required) First Last Legal Business Name (Including LLC or DBA)Name of main contact for the businessCompany Address: (Mailing & Physical If Different)Number of Locations: If multiple, please list addresses:Business contact phone number:Business contact email:What 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.Business Tax ID # (EIN #)Projected Annual Gross RevenueWhat type of operations does the revenue come from?How many employees do you have - (Part-Time & Full-Time)Any subcontractors used? If YES - 1099s?What type of insurance are you looking for? (Liability, Property, Commercial Auto, Workers Comp & Disabilty) Liability Liability & Property Coverage Commercial Auto Worker Comp & NYS Disability Other 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? If so, which carrier?Who is your current insurance company? How long have you been with them?What has you looking for new insurance?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 on your autos?Additional comments
