Restaurants, Caterers & Taverns

RESTAURANT QUOTE INFORMATION
First Name Required
Last Name Required
Legal Name of Business (DBA) Required
Business Type Required	Corporation Sole Proprietor Partnership LLC Other
Years in business under this name? Required
Primary Phone Number Required
E-Mail Address Required
Physical Location of Restaurant Required
ZIP / Postal Code Required
State Required	AL GA NC SC TN
Years at the Current Location Required
Is the Restaurant locatedf in a Shopping Center or Stand Alone Building? Required	Shopping Center Stone Alone Building Office Building Other
What type of insurance do you want us to quote? Optional	LiabilityLiquor BuildingContents Business AutoWorkers Compensation Umbrella
Describe Restaurant or Your Service Required
Cooking Style, Select which applies Optional	Wood Burning BBQ Pit Table Top Cooking Open Flame Cooking Kitchen Cooking at Restaurant Mobile Cooking
Is there a Cooking Ventilation System? Required	Yes No
Is there an In-Force Cleaning Contract? Required	Yes No Other
Total Building Square Footage (estimated) Required
Your Occupied Square Footage Required
Maximum Seating Capacity? Required
How Many Owners/Officers? Required
Annual Employee Payroll (Excluding Owners or Officers) Required
Number of Employees Required
Annual Gross Sales (Incluidng any Alcohol Sales) Required
Do you sell alcoholic beverages? Required	Yes No
If YES to Alcohol Sales, What % of Gross Sales for Alcohol? Required
Valet Parking, Provided? Required	Yes No
Is there any Type of Enterainment at the Restaurant Required	Yes No
Any Claims past 36 months from today? Required	Yes No
If Claims, please describe including the Year Required
Current Restaurant Liability Carrier Required
Current Work Comp Insurance Carrier Required
Is there anything you would like to tell us about your Quote Request? Optional
Please Let us know - How did you hear about us? 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
After you have sumitted your quote request, we will start working on your quote and we will help assist with obtaining your claim history. The insurance carriers require us to show prior proof of coverage along with claim history.
Thank you for your time and we will be in touch with you today unless this is after hours or on the weekend.
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