Name: Florida Prime Insurance
Address: 9251 S Orange Blossom Trl Suite 3, Orlando, FL, 32837, US
Telephone: (407) 367-1672

Business Insurance Quotes

Business Name & Legal Entity:
Year Business was founded:
Employer Identification Number:
Business Physical Address:
Street Address City State ZIP Code
Contact Name & Title:
Phone Number:
Email
Website:
Description of Operations:
Do you own or rent the business premises?
Building Information (Type unknown if not sure)
Square Footage of premise:
Year Built:
Construction type:
Roof Age:
Electric Age:
Plumbing Age:
HVAC Age:
Business personal property amount: (If you are a tenant include betterments & improvements) $
General Liability & Workers Compensation
Estimated Annual Gross Revenue:
Estimated Annual Payroll excluding owner(s):
List Owners Names & Annual payroll per owner:
Number of Employees
Eligibility Questions:
During the past three years has any company ever cancelled, declined, or refused to issue similar insurance to the application?
- Yes
- No
If yes, explain
Has the insured or applicant had prior coverage?
- Yes
- No
Has the insured or applicant had any prior claims or losses in the last 3 years?
- Yes
- No
If Yes, please provide loss information
Has the applicant filed for bankruptcy in the past 5 years?
- Yes
- No
Additional Comments
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Building Information (Type unknown if not sure)