Logo
Secured by SSL

Salon & Barber Shops


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

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




Mailing Address
Required
City
Required
State
Required
ZIP / Postal Code
Required
Business Type
Required




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

If Subcontractors are used, do you veritify that they have insurance?
Required


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
Do you own the Building?
Required

Operating in:
Optional




How much Contents Coverage should we quote or type "None"
Required
Construction Type
Required
Total Building Square Footage?
Required
Your Occupied Square Footage
Required
Year the Building was Built (est)
Required
Age of the Roof
Required
Is there a sprinkler system in building?
Required

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
CURRENT INSURANCE INFORMATION
Do you currently have Business Insurance?
Required

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

Number of Additional Insureds Needed, if applicable or type "NA"
Required
Has your business had any claims in the past 3 years?
Required

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
CAPTCHA
Change the CAPTCHA codeSpeak the CAPTCHA code
 
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.