Internal form to request a commercial quote Internal - Commercial Quote Contact Name* First Last How did you hear about us? (Lead Source) What's prompting you to look at your insurance? (Skip this if purchasing) (We're looking for pain points with their current policy - are they looking for a lower price, did they experience bad service, poor claims experience? )**OPTIONAL - What did your like or dislike most about your current agent/company? We want to know what to do or NOT to do to keep you as a customer for lifeA few questions about your business...Business Name:* Address:* Business Phone:*Tax-ID Number:* Nature of Business:*What type of work do you do? Number of Full-Time Employees?* Number of Part-Time Employees?* Annual Sales:* Does the building have sprinklers?* Yes No Does the building have an alarm?* Yes No Building InformationAre we insuring the building for the business?* Yes No Year Built:* Square footage:* Roof Type:* Roof Shape - (majority of roof) Hip Gable Complex or Elaborate (high value homes) Flat Employee InformationWould you like a workers compensation quote?* Yes No Number of Full-time Employees:* Number of Part-time Employees:* Annual Payroll Amount:* Description of Employees Duties:* Business PropertyComputers:* Product Inventory:* Signage: Deductible: Other:Prior InsuranceWhat company are you currently insured with? Any claims submitted for the business within the last 5 years? No Yes Please list any details about the claim - (Approx date and claim type) What are you currently paying for your business insurance? Contact InformationContact Phone:* "Do you mind if we text you once we have the quotes completed to let you know to look at your email?"Contact Email:* "What's the best email address for us to send the proposal once we've done our research with our multiple companies?"Are you okay with us following up with you with your options via e-mail and text messages?*YesEmail - YES, Text - NONotesAnything else we should know?This form was completed by:*Brian CichonJonathan BrewerJohn Bene
