Please fill out the following information below

Applicant Full Name(*)

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Restaurant Name:(*)

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Phone Number(*)

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E-mail(*)

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Address 1 (Risk Location):(*)

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Address 2 (Mailing Address):

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Postal Code:

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PREMISES

What is the building type of your premise?

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What is your building type?

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Number of stories

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What is the building material of your premise?

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Please describe the material

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FIRE PROTECTION

Is there a fire hydrant within 100 meters of your premise?

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What is the approximate distance to nearest fire hall?

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Do you have a sprinkler system?

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Do you do any deep frying?

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Describe the Automatic Fire Suppression System:

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SECURITY

Do you have a monitored burglar alarm system?

YesNo Invalid Input

Please describe the system:

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Please state the name of monitoring company

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Do you have a safe? If yes, describe what type:

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What is the maximum amount of cash on premises?

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COVERAGE LIMIT

Building: $

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Contents: $

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Equipment Breakdown Coverage

YesNo Invalid Input

Exterior Signs: $

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Crime (Money and Securities): $

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Business Interruption: $

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General Liability

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Annual rent from tenants: $

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GET RESTAURANT INSURANCE

PREMISES

FIRE PROTECTION

SECURITY

COVERAGE LIMIT