HAYES INSURANCE AGENCY

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Commercial General Liability

This questionnaire 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
Daytime Phone() -
Fax() -
E-mail Address
Briefly describe your business operations:
Annual GROSS receipts
# of employees (full & parttime)
Annual employee payroll
Are you currently insured
If yes, when does your policy expire
If no, have you ever had insurance
Comments
Do you use subcontractors
Any new construction (of any kind) provide details
How long have you been in business
Please give the name of the broker you are working with (if any)