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Please complete ALL SECTIONS and we will contact you within 24 Hours. General Information Insured's Name Phone Number Fax Number Email Address Insured is: Please Choose Individual Partnership Corporation Joint Venture Business Name Street Address City Zip Code CA Area SqFt. Year Built Annual Payroll Annual Receipts Liquor Sales Loss History Prior carrier and loss history for the past three years From Mo. Yr. To Mo. Yr. Company Name Policy number Cancelled or Non-renewed No Yes Reason Coverages Desired: General Liability Assault & Battery Liability Yes , No Liquor Liability Yes , No Business Personal property & Contents Business Interruption Sign Coverage Food Spoilage Yes , No If you have already been given a quote, entering the figure here may help you get a better deal How did you hear about us Internet News Paper Advertising Yellow Pages Referral Friend Other Please ensure all the required sections are completed in order to provide you with an accurate quote.
If you have already been given a quote, entering the figure here may help you get a better deal
Please ensure all the required sections are completed in order to provide you with an accurate quote.
TELEPHONE (310) 551-1235 & (310) 551-1236 Fax (310) 551-1250 400 South Beverly Drive, Suite 318, Beverly Hills, Ca 90212. USA. E-MAIL sales@concordgeneralinsurance.com
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