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*indicates required fields *Wholesale Business (Must specify) Accounting & Adding Machine Air Conditioning & Heating Equipment Aquarium Supply Art Supplies Audio Visual Equipment & Supplies Auto Parts & Accessories Bakeries Beverage (non-alcholic) Book & Magazine Bridal Clothing Building Maintenance Supplies Business Machines Supply Camera & Photographic Supply Candy,Nut & Confectionary (no cooking) Carpet, Rug & Floor Covering Church Supplies Clocks Cloth Goods & Yarn Clothing, Mens' & Boys' Clothing, Ladies' & Girls' Clothing, Children's & Infants' Wear Coffee, Tea & Spice (condiments) Copying & Duplicating Supplies Corsets & Girdles Dairy Products - Eggs, Ice Cream Electrical Fixture & Supplies Equipment Fixtures for Bars,Hotels,Restaurants Fabrics including Dry Goods, Yarn & Piece Goods Fish & Seafood Florists Furniture Gift Stores Glove & Handbag Groceries Hardware (no power tool rental) Health Foods Hearing Aids Hobby Supplies (no coin,stamp & $$$ collectors items) Hosiery Household Appliances Kitchenware & Cutlery Lamps, Lampshade & Light-Fixture Lawn & Garden Supply Leather Goods Maternity Meat,Fish & Poultry Mirrors Music,Tape & Records Office Furniture Office Machines Optical Goods Organs & Pianos Paint,Glass & Wallpaper Pet Supply Photographic Equipment Picture Frames Plumbing Fixtures & Supplies Pottery Equipment & Supplies Radios Religious Goods School Supplies Sewing Machines Shoes Slipper,Rubbers & Boots Sporting Goods Stationary Supplies Stereos,Record Players & Tape Recording Sunglasses Television & Radio Sales Tobacco, Pipes & Smokers Articles Toys & Games Typewriter Sales Vacuum Cleaner Sales Other *Contact Person *E-mail Company *Address *City County State *Zip Code Home Phone Work Phone FAX   Address City County State ZipCode   *Year Built Construction Type Stucco/Masonry Frame (predominantly wood) Non-Combustible Building Type 1 to 4 Stories 5 Stories & over Basement Type None Unfinished Basement Partially Finished Basement Finished Basement Air Conditioning No Air Conditioning Window Air Conditioners Central Air Conditioning Parking Type Carports Garage or ground level parking under roof Underground parking Enclosed Parking Sq.Footage Building Sq.Footage Elevators Yes No Building Owner Occupied Yes No Loss of Income/Rents Yes No Building Sprinklered Yes No Enclosed Access? Yes No   *Building Coverage (Enter zero if coverage not required) *Contents Coverage (Enter zero if coverage not required) Liability Limits $100,000 $300,000 $500,000 $1,000,000 $2,000,000 Deductible Options $500 $1,000 $2,500 $5,000 $10,000 Property of Others Exterior Signs Employees at Location Full Time Part Time Employee Dishonesty None $5,000 $10,000 $20,000 $30,000 $40,000 $50,000 Spoilage None $2,500 $5,000 $7,500 $10,000 $20,000 $30,000 $40,000 $50,000 Earthquake Yes No Building Laws Yes No Water Damage Yes No Hired Auto Yes No Employer's Non-Owned Auto Yes No Heating & Air Conditioning Equipment Basic Broad Heating Boilers   Current Insurance Expiration Date   Have you had any building losses within the last three years? If yes, please explain in remarks below:   How would you like to receive your free quote? U.S.Postal E-mail Fax