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Nail Salon Questionaire

APPLICANT:
Applicant Name:
Name of Salon:
Phone #:
Email:
MAILING ADDRESS:
Street Address:
City/State/Zip
STREET ADDRESS:
Street Address:
City/State/Zip:
EXPERIENCE:
How long in business?
How many years experience doing nails?
How many Nail Techs full-time?
How many Nail Techs part-time?
Estimated Annual Receipts:
WHAT KIND OF SERVICES DO YOU PERFORM?
What kind of services do you perform?
If tanning, how many beds:
If other, explain:
POLICY:
Desired Policy Period? From:
To:
How much coverage on contents in salon? (must be at least 25,000)
BUSINESS TYPE:
Business Type:
If other, expalin:
BUSINESS LOCATION INFORMATION:
Business Located in:
Construction of Building:
Sprinkler System:
Sq. Feet of Insured's Premises:
Distance to responding Fire Dept:
Additional Insured:
Details of Additional Insured:
Prior Insurance Carrier and Loss History (3 years):
Year 1:
Year:
Company:
Policy #:
Premium:
Loss Amount:
Description:
Year 2:
Year:
Company:
Policy #:
Premium:
Loss Amount:
Decription:
Year 3:
Year:
Company:
Policy #:
Premium:
Loss Amount:
Description:
PLEASE NOTE:
In order for applicant to get coverage, they must provide us with documentation that there have been no losses.
When coverage is bound, insured must sent 2 checks, one for agency service fee & one to company for premium.
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