Salon & Barber Shops

BUSINESS INSURANCE QUOTE FORM
The Quote Form is our preliminary process of obtaining the necessary underwriting information. Be as thorough as possible. The current policy and claim history will also be required as part of the underwriting process.
First Name Required
Last Name Required
Contact Primary Phone Number Required
E-Mail Address Required
Business Legal Name Required
Doing Business As Name or Type "NA" Required
Number of Years in this Business? Required
What type of Insurance do you want us to quote? Optional	LiabilityBusiness Auto EquipmentBuilding ContentsUmbrella Workers Compensation
Mailing Address Required
City Required
State Required	AL GA NC SC TN
ZIP / Postal Code Required
Business Type Required	Corporation Sole Proprietor Partnership LLC Other
Describe your Business Operation: Salon, Barber Shop, School, etc Required
Location Address Required
City, State & Zip Required
Current Estimated Gross Annual Sales or Receipts Required
Number of Owners or Officers Required
Number of Employees (excluding Owners and Officers) Required
Annual Employee Payroll (Excluding Owners or Officers) Required
Are Subcontractors Used? Required	Yes No
If Subcontractors are used, do you veritify that they have insurance? Required	Yes No No Subcontractors Used
Number of Non Employees 1099s Required
Annual Cost of Non Employees 1099s or type "NA" Required
Annual Cost of Subcontractors or Type "NA" Required
BUILDING & CONTENTS INFORMATION
Where is the Salon or Shop operating? Required	Shopping CenterStand Alone Commercial Building Nursing HomeYour Home Someone Else's HomeHospital Renting a Station
Construction Type of the Building or Home Required	FrameFrame with Brick Concrete BlockMetal Concrete with SteelOther I don't know
Your Occupied Square Footage Required
Estimated Year the Building or Home was built? Required
Age of the Roof Required
Is there a sprinkler system in building? Required	Yes No
Do you own the Building? Required	Yes No
How many Beauticians or Barbers "Full Time" Required
How many Beauticians or Barbers "Part Time" Required
How many Beauty or Barber Chairs? Required
How many Manicurists "Type None" if not applicable Required
How many Tanning Beds or Booths "Type None" if not applicable Required
How many Beauty School Teachers - type "NA" if not applicable Required
Does the Salon or Shop Offer Botox or Filler Injections? Required	Yes, We Offer No, We did not Offer Botox or Fillers
Does a Doctor or Licensed Practitioner Preform any type of service at the Salon or Shop? Required	Yes No
Other than what has been asked above, are there any other Services offered by the Salon/Shop or by an Independent Contractor? Type "None" or please describe. Required
How much Contents Coverage should we quote such as: The Cost to Build Out; All Inventory Added Up; All Other Contents Items Required
CURRENT INSURANCE INFORMATION
Do you currently have Business Insurance? Required	Yes, I currently have Business Insurance No
If yes, please provide name of current Insurance carrier. If no insurance, type "NA." Required
Has there been a lapse in coverage in the last 3 years? Required	No, there has not been a lapse in coverage. Yes, there has been a lapse in coverage.
Number of Additional Insureds Needed, if applicable or type "NA" Required
Has your business had any claims in the past 3 years? Required	Yes No
Is there anything else that you would like for us to know concerning your quote request? Optional
How did you hear about us? Please let us know Required
SIGNATURE REQUIRED
I have provided all of the above information for insurance purposes and I state all information is true to the best of my knowledge. I also understand that I am to discuss with the agent at D. Ward Insurance my desired limits and coverage.
By typing my name warrants my signature. Required
ADDITIONAL INFORMATION NEEDED
Please note - if the Business is insured, a copy of the policy and claim history will be required. They can be obtained from your current agent by requesting the documents to be sent electronically to you.
Thank you for time and we will be in touch with you today unless this is after hours or on the weekend - Debbie Ward and Valerie Moore
ENTER VALIDATION CODE
For Security of your personal information, enter code and press submit
Submission Validation Required	Enter the Validation Code from above.

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages.  Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company.  If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

Insurance Websites Designed and Hosted by Insurance Website Builder