UNITEL New General Liability Questionnaire

Company Information
Company Name:*
DBA (if applicable):
FEIN:*
Company Headquarters Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Company Website:
Company Type:*
Brief Description of Operations:*
Contact Information
Contact Name:*
First Last
Contact Email:*
Contact Phone:*
Policy Information
Policy Effective Date:*

MM slash DD slash YYYY
Year Business Established:*
Annual Sales (projected):*
Square Footage:*
*Refers to area of business office- if out of your home for now, note area used for business
Number of Employees:*
Umbrella Limit Required:*
Desired Limit*
Any contract require a Waiver of Subrogation?*
Name and Address of who is requiring?*

Company Information