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More than One Location?
Building Address:
Building City, State, Zip:
Building County:
Tax ID # or SSN:

Detailed Description - Business Type:

Entity Type:
Years in Business:
Liability Information:
Coverage Amount:
Currently Insured:
How Long:
How Many Part Time Employees?
Property/Contents Information:
Do you want building coverage?
If yes, amount of coverage?
Year built:
If yes, amount of coverage
Percent (%) Occupied:
Approximate square footage of occupied space:
Additional Address (if applicable):
Workers Comp:
Number of Full Time Employees:
Number of Part Time Employees
Commercial Auto Section:
Driving Radius for vehicles
Current Insurance Company:

Precise Advantage Insurance Agency