HAYES INSURANCE AGENCY

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Business Owners Policy (BOP)

This questionnaires is used to obtain information about your business operations. In most cases, we will need to obtain more information from you in order to provide you with an accurate quote.

The online questionnaires are a starting point and are very helpful in our quoting process. Please try to be as accurate as possible when answering these questions. Thank you.
First Name
Last Name
Company Name
Address Line 1
Address Line 2
City
State
Zip Code
Phone #
Fax() -
E-mail Address
Please give a brief description of your business operations
Do you own or rent your business space
Do you need coverage for the building
If yes, how much
Do you need coverage for your business/personal property
If yes how much
What limits of liability are needed
# of employees [full or part-time]
Annual employee payroll
What are your annual GROSS receipts
How long have you been in business
Comments
Please give the name of the broker you are working with (if any)