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Of the following, what is the primary reason for a quote request?
Requesting More Information
Landlord Required
Replace Investment
Liability Protection
In the order of importance, what is most important to you?
Price
Service
Proper Coverage
Approximately when was the last time you did a review with your agent?
Within the year
Over 2 years ago
Over 5 years ago
Never
Would you be interested in going to higher deductibles to reduce your premium?
Yes
No
In the event of a lawsuit, accident, or judgment would you want to:
Maximize Protection
Assume Some Risk
In the event of an untimely death, is it important to you that you're surviving spouse and/or children maintain the quality of life you currently have together without debt?
Yes
No
Would you be interested in combining your commercial insurance for additional savings?
Yes
No
If health insurance is provided for employees, would you like to save money?
Yes
No
Requesting More Information
Has your current company/agent failed to meet your expectations in any way?
Yes
No
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Current Insurance Information
Current Insurance Company
Current Policy Expiry
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2015
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Type of Business
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Single Proprietor
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LLC
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Accounting Offices
Animal Specialty
Architectural Services
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Offices and Clinics of Dentis
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Offices of Osteopathic Physicians
Offices and Clinics of Podiatrists
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Services NOC
Surveying Services
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Year Established
Number of Office Locations
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Number of Employees
Building Cost
Equipment Total Value
Annual Gross Revenue
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Additional Information