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Restaurant "Quick Quote" Application
Your Name/Restaurant Name:
Contact Phone Number:
Your E-Mail Address:
Confirm E-mail Address Again:
Location City, State and Zip Code (Must be in New York):
Restaurant Type:
Choose One
Fine Dining
Casual
Pizza (Delivery)
Pizza (No Delivery)
Fast Food
Bar / Tavern (Food)
Bar / Tavern (No Food)
Nightclub (Live Entertainment)
Nightclub (No Entertainment)
Gentlemen's Club
Other
Current Insurance Company:
Renewal Date:
Current Cost:
Any Claims in the Last 3 Years?
Choose One
Yes
No
Liquor Liability Included in Current Coverage?
Choose One
Yes
No
Building Coverage:
Choose One
Own the Building
Do NOT Own the Building
Age of Building:
Business Property Amount:
Ansul Type:
Deductible:
Catering?
Choose One
Yes
No
Patio?
Choose One
Yes
No
Live Music?
Choose One
Yes
No
DJ?
Choose One
Yes
No
Total Square Footage:
Public Access Sq. Ft.:
Approximate Gross Sales:
Food Sale %:
Alcohol Sale %:
Number of Employees:
Cronin Insurance Agency
11395AA West Palmetto Park Road
Boca Raton, FL 33428
Toll Free: 1-888-427-6646
Phone: 1-561-479-1898
Fax: 1-561-479-1386
E-Mail:
petercronin@cronininsurance.com
Web Site:
www.cronininsurance.com
Terms of Use/Privacy Notice/Copyright Info.
Cronin Insurance Agency. Design © 2005
Insurance-Web-Sales
Please report site-related technical problems to:
petercronin@cronininsurance.com
(This page last updated March 30, 2005)
