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Puharic and Associates, Inc.
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Homeowner Questions
Commericial Questions
General Liability Questions
Workers Comp Quetions
Cyber Questions
Life Insurance Questions
Builders Risk Questions
Commercial Interview Questions
What is your name?
*
Email
Phone
Full name of business including INC, LLC, DBA, (all commas, all periods in correct place)
*
What kind of company are you?
Federal ID number
Any other names that you receive revenue in?
Yes
No
Name all owners and percent of ownership
Explain to me what you do as if I were a 5th grader.
Do you derive revenue in any other way?
Full mailing address
Multi-line address
Country/Region
Address
City
Zip / Postal code
Full physical address for location
Multi-line address
Country/Region
Address
City
Zip / Postal code
Which are you?
Tenant
Owner of Building
Other questions
What are your annual sales?
Number of employees
Annual Payroll?
Do you own a vehicle?
Yes
No
Do you have tools or equipment
Yes
No
Do you have loose tools (hammers, drills, etc.)
Yes
No
Do you currently carry Umbrella?
Yes
No
Do you have Employer Practices Liability Insurance (EPLI)?
Yes
No
Do you have Cyber?
Yes
No
Is there anything else we should know before start the quote? (optional)
Do you own any other businesses?
Yes
No
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