Request Policy Change

    Business and Contact Information

    Business Name:*

    Your Name:*

    Contact Email Address:*

    Contact Phone Number:*

    Has the business mailing address changed?*
    YesNo

    If yes, please provide new mailing address:

    Please Check All That Apply
    Other changes not listedWe have upgraded our building(s) and or fixturesWe now lease out a portion of our locationOur mortgagee or finance company information has changedOur ownership interest in our building has changed (e.g., rent vs. own)Our business has movedWe have reduced business locationsWe have added business locations

    If you checked any box above, please explain:

    Operations

    Please Check All That Apply:
    Have there been other changes to your business operations?Have you assumed any contractual obligations as a result of your business operations?Have you contracted out portions of your business operation?Have you changed the states where you do business?

    If you checked any box above, please explain?

    Business Personal Property

    Have you added to or reduced your business personal property?*
    YesNo

    Has there been a change to the location where business personal property is kept?*
    YesNo

    Please describe any other changes to your business personal property:

    Other Business Information:

    How many employees do you now have?*

    What are your sales projections for the next year?*

    What is your projected inventory for next year?*

    What is your projected payroll for the next year?*

    Risk Management and Insurance Needs

    Please check the boxes below for more information about protecting your business future:
    Business ContinuationBondsGroup BenefitsCrime InsuranceCommercial UmbrellaCommercial LiabilityCommercial PropertyEmployment Practices LiabilityDirectors and Officers InsuranceErrors and Ommissions Insurance

    Do you have any comments or are there any questions we can answer?


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