Muller Insurance - Complete Insurance Packages for Individuals and Businesses

Building Insurance Quote

Contact Information
Date:		Need By (Date):
Expiration date:		Need original for closing?	Yes No
Contact Name:		Contact Email:
For inspection:
Mobile #:		Work #:
Home #:		Fax #:
Building Information
Owner's Name (As on deed):		Property Address:
Property City:		Property State:
Property County:
Mailing Address:		How many units in building?
Owner occupied?	Yes No	Annual Rental Income:
Business on premises?	Yes No	Business Type:
Any vacancies?	Yes No	Business square footage:
Do you live in the Building?	Yes No	How many years?
Construction:		Year gutted?
Measurements of building only:	Width:	Length:	Floors: Sq. ft.:
Exposure left:	Ft.	Exposure right:	Ft.
Year Built:		Condition:
Heating System:
Does Building have Sprinklers?	Yes No	Totally sprinklered?	Yes No
Sidewalk Condition:		Any cracks, holes, raised?
Updates? When (date):	Roof : Plumbing: Heating: Electric Amperage:
Does Building have any alarms?	Smoke: Central Burglary: Central Fire: Local Gong: Roll Gates: Annunziators: Stand Pipes:
Insurance Information
How much fire insurance needed on building?		Other:
Building Fire Deductible:		Other:
How much liability in public areas needed?		Umbrella amount in Millions:
Need Boiler & Machinery Insurance?	Yes No	Need Flood insurance?	Yes No
Medical Payments?
Building have superintendent?	Yes No	Need Workers Compensation?	Yes No
Annual Payroll of superintendent:		Payment Plan:
Additional Information
What company insures you now?		Current premium:
Why do you want to switch?	Pricing: Switch Agent: Being Cancelled: Cancelled:
Been cancelled in last 3 years?	Yes No	If yes, why?
Losses in the past 5 years?	Yes No	If yes, type of Loss:
If yes, date of Loss:		If yes, amount of Loss:
Referred by:		Other:
Notes:


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