Donoyan Insurance Agency, Inc.

After completing this form, please click the SUBMIT button to receive your free Insurance Quote.

You'll be given an opportunity to specify U.S. Postal Service, e-mail or fax.
Or call us toll-free at 877-DONOYAN (366-6926).

*indicates required fields

*Business Type

*Business Name

*Name of Applicant

*E-mail

*Location address

*City

State

*Zip Code

Home Phone

Work Phone

FAX

The following are guidelines for this in-home business program:

Professional liability is excluded on all classes

Medical Payments of $5,000 each person included (under liability coverages)

Standard deductible is $100 (no other deductible available)

Address

City

County

State

ZipCode

Applicant is :
Individual   Partnership   Corporation   Joint Venture

Interest in Premises
Own       Rent

Dwelling Occupancy
Single   Multiple

Dwelling Construction
Frame   Masonry

Years in Business

Business Description

Business Personal Property
(Between $5,000 to $50,000)
  (No Building Coverage)

General Liability

Electronic Data Equipment
(Maximum $25,000)
  (Off-premises Maximum $5,000)

Money & Securities
(On/Off Premises)
$1,000/$1,000   $2,000/$1,000   $3,000/$1,000
$4,000/$1,000   $5,000/$2,000   $7,500/$2,000
$10,000/$5,000

If you answer YES to any question or leave any unanswered,
you will not be eligible for coverage.

Yes
No
1. Is your business based in an area other than your residence (residence includes outbuildings within 100 feet)?

Yes
No

2. Have you had more than two claims of any type, related to your Business operation, in the last three years?

Yes
No

3. Have you had a single claim, related to your business, for more than $25,000 in the past three years?

Yes
No

4. Do you own any business under the same legal name as the "Business Name" shown, which is permanently operated from a second location??

Yes
No

5. Do you repackage food or personal care products to be sold under your own label?

Yes
No

6. Are you involved in the sale or manufacturing of explosives or propellants?

Yes
No

7. Do you install any products, excluding the installation of computer systems, office equipment, security devices or draperies?

Yes
No

8. Is your business operated by someone other than yourself and/or another immediate family member who resides in your household?

Yes
No

9. Did your gross annual sales/receipts from your business pursuits for the most recent calendar year exceed $250,000 for sale of merchandise or $500,000 for s service business?

Yes
No

10. Do you employ more than ten (10) employees, other than independent contractors or distributors?

Yes
No

11. If you are a teacher or tutor (rather than a personal fitness trainer), do you provide instruction for sports, physical education, industrial arts, or martial arts?

How would you like to receive
your free Home Business quote?
U.S. Postal E-mail Fax