CL Renewal Questionnaire

"*" indicates required fields

Business Name*

Full Name:*

First Last

Phone Number:*

Email Address:*

Mailing/Correspondence Address:*

Street Address Address Line 2 City State ZIP Code

Are there any significant changes in your business operation in the last 12 months? (Merger/Acquisition, New lines of business, new operations, new locations, etc.)

How many W-2 employees does your team currently have?*

What is your projected total W-2 payroll for the upcoming 12 months?*

What is your projected gross revenue for the upcoming 12 months?*

What is your projected total paid to subcontractors or 1099 team members for the upcoming 12 months? (if applicable)

If you have acquired any new property, added locations, or made other changes that effect your insurance needs, please detail them here.

Do we need to add any additional insured's to your policy? (Bank, landlord, new contracts, etc)

Is there anything else that we need to know now to make sure your insurance program is exactly what you need?

You may upload up to 3 files to us, if necessary.

Drop files here or

Max. file size: 39 MB, Max. files: 3.

CAPTCHA