Business Insurance Smart Intake

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Section 1

Business & contact

Legal business nameDBA or trade nameFederal Tax ID / EINProtected information. Stored encrypted and masked by default in the agency workspace.First nameMiddle name / InitialLast nameEmail addressPhone numberCurrent addressMailing address, if differentCityStateZIP codeMove-in dateHow long at this address?Business websiteEntity typeYear establishedYears of relevant owner experienceRequested effective datePreferred contact method

Owner or officer

Owner or officer 1

Full legal nameTitleOwnership percentageRelevant experience in years

Section 2

Address history

Previous address

Add prior residences needed for underwriting. These remain connected to the applicant's address history.

No previous address added. Add one only when applicable.

Section 4

Financials & workforce

Annual gross revenueAnnual payrollValues and applicable periodFull-time employeesPart-time employeesOwners and officersAnnual subcontractor costsUses independent contractors?Largest payroll class or job type

Section 5

Locations & property

Business location

Business location 1

AddressOccupancyOwned or leasedSquare footageConstructionYear builtEquipment, inventory, furniture, and tenant-improvement valuesFire, alarm, sprinkler, and security protectionBusiness-interruption concern

Section 6

Liability & exposures

Coverage interests General liability Products and completed operations Professional services Cyber or electronic data Commercial property or BOP Commercial vehicles Workers compensation Umbrella or excess Additional insured requirementsContractual or additional-insured requirements

Section 7

Insurance & losses

Currently insured?Any lapse in coverage?Cancellation or nonrenewal detailsLoss runs available?

Business loss

No business loss added. Add one only when applicable.

Section 8

Documents

Optional supporting PDFs

Up to 10 PDF files, 25 MB each. Files are validated and security-scanned before storage.

Business Insurance Smart Intake