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Questionaire Please complete the following form and submit to Flavin & Flavin Insurance Agency for a quote. (This is not to be considered a binder or insurance coverage) .
Company name:
Address
City State Zip Code
Phone number: Fax number: Email:
Type of Insurance desired:
Select below: Home Auto Dwelling Business Flood Liability Contractors Workers Comp. Bond Commercial Property
Location:
Is it the Primary Location?:
Yes No
Amount coverage desired:
Age of Property:
Select below: 0 - 1 years 2 - 5 years 6 -10 years 11 - 15 years 16 - 20 years 21 - 30 years 30 - 50 years 51 - 75 years 76 - 100 years over 100 years
Type of Construction:
Select below: Wood Frame Joisted Masonry Fire Resisted Brick Veneer Concrete
Square Feet:
Select below: under 1000 sqft. 1000 - 2000 sqft. 2000 - 3000 sqft. over 3000 sqft. I am not sure
Number of Families:
Select below: single 2-family 3-family 4-family more than 4 family Commercial building
Type of Business:
Select below: Office Commercial Apartments Other
How long in Business:
Any updates to the roof, plumbing, heating or electrical systems, etc. recently:
If YES, please describe:
Any Prior Losses:
Additional information may be necessary for a final quote. A representative of Flavin & Flavin will contact you.
THANKS you for your request for a quote. (This is not to be considered a binder or insurance coverage).