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Secure Commercial Renewal Review

 
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Operations

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If "Yes", please explain:
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If "Yes", please explain any changes in payroll/employees.:
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If "Yes", please explain:
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If "Yes", please explain:

Property

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If "Yes", please provide current estimated value of business personal property.
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If "Yes", please explain and provide costs of any improvements or additions.:
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If "Yes", please explain:

Auto

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If "Yes", and you would like to update this information, please provide year, make, model, and purchase price of any new vehicles, and date-of-sale for any sold vehicles:
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If "Yes", and you would like to update this information, please provide the driver's name, date of birth, and driver's license number:

Miscellaneous Information

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Please list anyone you feel would benefit from our services:
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Neutral
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Completely Dissatisfied
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Website Disclaimer - Review Carefully:

This is a solicitation for insurance. Insurance coverage cannot be bound or changed via submission of this online form/application, e-mail, voicemail or facsimile. No binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly with a licensed agent. Note any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form/application and/or in communications with us. All coverages are subject to the terms, conditions and exclusions of the actual policy issued. Not all policies or coverages are available in every state. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.