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Which industry is your business most closely related to?.
Engineering and Architecture
Beauty, Spa, and Aesthetics
Finance, Real Estate
Healthcare and Wellness
Protection and Security Services
Restaurants and food services
Sports & Fitness
Please enter the industry of your business:
Please enter your gross revenue for the past 12 months:
Please enter the legal name of your company (not trade name):
Are you a certified professional for the services you do?
Please enter the type of your company:
Individual / Sole Proprietor
Number of full time personnel including owners:
Number of part time personnel (less than 2 days per week):
Please select the services you provided:
Acupuncture or acupressure
Electrical heat or steam baths
Eye lash extensions/perms
Face lifting/plastic surgery
Hair care services
Injections (any kind)
Make-up (permanent or tattoo)
Piercing (other than nose or ears)
Reiki, reflexology, or aromatherapy
Removal of warts, moles, or growths
Please enter your treatment:
Has there been any claims, accidents or injury in the last 10 years?
Please describe the situation:
Is this a newly opened business?
How many years have you been in this location:
Are you new to this industry?
How many years have you been in this industry?:
Please list the values of any tools and equipment you use (if any):
Requested cause of loss:
Actual cash value
Business personal property limit $:
Business income and extra expense limit $:
Building limit: $
What year was the building constructed?
Applicable sq.ft of Apartments:
Is the building fully protected by an operational sprinkler system covering 100% of the premises?
$100,000 / $200,000
$300,000 / $600,000
$500,000 / $1,000,000
$1,000,000 / $2,000,000
Is any portion of the building leased to commercial tenants?
Please state the applicable sq. ft.:
Does the applicant lease any apartments at this location?
Number of Units:
Please fill out the following information below
Applicant Full Name:
Please enter your full name.
Invalid phone number.
Invalid E-mail Address.
Please tell us your address
What is the square footage of the entire structure? (Sq. ft.)