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Business Insurance Questionnaire

Please take the time to review the questions below to determine if you have had any changes to your business, that could have an impact on your insurance, since the last time you met with a Business Insurance Representative. If you select any of the options below, please submit the form or contact us to discuss your policy. Our normal business hours are Monday through Friday 8 am to 8 pm Eastern Standard Time.

* Fields marked with an asterisk are required. Policy Holder Contact: Business Name: (as it appears on your policy) What is the primary state that your business operates in? Phone Number: Fax Number: E-Mail Address: Website: Please call me to discuss my insurance The best time to reach me is a.m. p.m.

Since you last discussed your policy with insurance professional

Have there been any changes or additions to your business operation(s)? Have you purchased any new property (e.g., computers, tools, equipment, autos, etc.)? Have you made improvements or changes to your existing location(s)? Have you moved your business location(s)? Have you changed your business mailing address? Have there been any changes in your staffing? Have you changed your mortgage company(ies) (e.g., banks or finance companies holding interest on any buildings insured by Travelers)? Have there been any changes in Loss Payees (e.g., banks or finance companies holding interest in your business personal property such as equipment, vehicles, computers, etc.)? Would you like a no obligation quote for any other lines of insurance?

If you have the renewal questionnaire that was sent to you in the mail please enter the following information from the bottom of that form.

SAI Number: Renewal Effective Date: Registration Number: Agency Code: