Copy of Franchisee Questionnaire

Step 1 of 3

33%

Tell Us About Your Company

Company Legal Name(Required)

Business Structure(Required)

Define 'Other'

List All Owners/Members/Partners(Required)

Name

Ownership Percentage

Include or Exclude from Work Comp?

Company FEIN(Required)

Describe Your Business Operations(Required)

Primary Business Contact

Who should we contact with insurance-related questions regarding your business?

Name

First Last

Preferred Method of Contact

Contact Type

Owner, Authorized Representative, Administrator, Etc.

Email Address(Required)

Email Address Confirm Email Address

Phone(Required)

Business Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Tell Us About Your Business Location(s)

Number of Locations to be Insured?(Required)

Location # 1 Details

L1 - Physical Address of Location(Required)

Same as business mailing address

Street Address Address Line 2 City State ZIP Code

L1 - Is this location currently insured?(Required)

L1 - Is there a lender associated with this location?(Required)

L1 - Is this location currently open?(Required)

L1 - Actual Opening Date:(Required)

MM slash DD slash YYYY

L1 - Projected Opening Date:(Required)

MM slash DD slash YYYY

L1 - Is This Location Owned or Leased:(Required)

L1 - Building Size (Sq Ft):(Required)

Total square footage of the owned building

L1 - Leased Space Size:(Required)

Total square footage of the leased premise

L1 - Estimated Value of Tenant Improvements:(Required)

Total Value of tenant improvements, including any TI allowance from landlord. Please do not include any equipment, furniture, or inventory.

L1 - Estimated Value of Business Property/Contents:(Required)

Total Value of Business Personal Property (Contents). Please include any equipment, furniture, and inventory.

Section Break

Location # 2 Details

L2 - Physical Address of Location(Required)

Street Address Address Line 2 City State ZIP Code

L2 - Is this location currently insured?(Required)

L2 - Is there a lender associated with this location?(Required)

L2 - Is This Location:(Required)

L2 - Is this location currently open?(Required)

L2 - Actual Opening Date:(Required)

MM slash DD slash YYYY

L2 - Projected Opening Date:(Required)

MM slash DD slash YYYY

L2 - Building Size:(Required)

Total square footage of the owned building

L2 - Leased Space Size:(Required)

Total square footage of the leased premise

L2 - Estimated Value of Tenant Improvements:(Required)

Total Value of tenant improvements, including any TI allowance from landlord. Please do not include any equipment, furniture, or inventory.

L2 - Estimated Value of Business Property/Contents:(Required)

Total Value of Business Personal Property (Contents). Please include any equipment, furniture, and inventory.

Section Break

Location # 3 Details

L3 - Physical Address of Location(Required)

Street Address Address Line 2 City State ZIP Code

L3 - Is this location currently insured?(Required)

L3 - Is there a lender associated with this location?(Required)

L3 - Is this location currently open?(Required)

L3 - Is This Location:(Required)

L3 - Actual Opening Date:(Required)

MM slash DD slash YYYY

L3 - Projected Opening Date:(Required)

MM slash DD slash YYYY

L3 - Building Size:(Required)

Total square footage of the owned building

L3 - Leased Space Size:(Required)

Total square footage of the leased premise

L3 - Estimated Value of Tenant Improvements:(Required)

Total Value of tenant improvements, including any TI allowance from landlord. Please do not include any equipment, furniture, or inventory.

L3 - Estimated Value of Business Property/Contents:(Required)

Total Value of Business Personal Property (Contents). Please include any equipment, furniture, and inventory.

Section Break

Location # 4 Details

L4 - Physical Address of Location(Required)

Street Address Address Line 2 City State ZIP Code

L4 - Is this location currently insured?(Required)

L4 - Is there a lender associated with this location?(Required)

L4 - Is this location currently open?(Required)

L4 - Is This Location:(Required)

L4 - Actual Opening Date:(Required)

MM slash DD slash YYYY

L4 - Projected Opening Date:(Required)

MM slash DD slash YYYY

L4 - Building Size:(Required)

Total square footage of the owned building

L4 - Leased Space Size:(Required)

Total square footage of the leased premise

L4 - Estimated Value of Tenant Improvements:(Required)

Total Value of tenant improvements, including any TI allowance from landlord. Please do not include any equipment, furniture, or inventory.

L4 - Estimated Value of Business Property/Contents:(Required)

Total Value of Business Personal Property (Contents). Please include any equipment, furniture, and inventory.

Additional Coverages

Does your Franchise Agreement require any of the following coverages:

Commercial Auto Liability(Required)

Yes

Commercial Umbrella(Required)

Yes

Cyber Liability(Required)

Yes

Liquor Liability(Required)

Yes

Employment Practices Liability(Required)

Yes

Other Coverage Not Listed(Required)

Yes

Describe 'Other' Required Coverage(s)

Please Upload Any Relevant Documents Here

Supporting Files or Documents

Drop files here or

Max. file size: 98 MB.

Examples: Current Policy Declarations Page; Loss Runs; Owner/Officer Work Comp Exemption Election Certificate; Lease Insurance Requirements; Lender Insurance Requirements; FDD Insurance Requirements