Commercial Insurance Intake Form Commercial Insurance Intake Please complete the details below. Fields marked with (*) are required. 1. Business Name (DBA) * 2. Entity Name (Legal Name) * 3. Business Address * 4. Mailing Address * 5. Is there a sprinkler system? * Yes No 6. Total Annual Sales ($) * $ 7. Estimated Liquor Sales ($) * $ 8. FEIN (Federal Tax ID) * 9. Loss Run Report (Optional File Attachment) 10. Business Personal Property ($) * $ 11. Square Feet You Occupy * Submit Intake Form
