CREATING PEACE OF MIND
SINCE 1964

Business Insurance Form

Who Referred you to Santa Cruz Insurance:

If an individual referred you please leave their name so that we can send a thank you:

First name:

Last name:

Email:

Phone:

Business name:

Description of operations:

Years in business:

Physical address of business:

FEIN:

Annual sales:

Property/coverage

Address where Business Personal Property/Special Equipment is stored

Address:

Square Footage:

Year of building:

Age of roof:

Age of updated electrical:

Age of updated HVAC:

Age of updated plumbing:

Description and value of any special equipment or Business Personal Property:

Commercial Auto coverage

Year, make, model, and VIN of all vehicles (or attach doc):

File upload

Driving radius:

0-50 miles

>50 miles

Full name, DOB, and Drivers License of ALL drivers (including Office Staff):

File upload

Work Comp Insurance

Number if full time employees:

Number of part time employees:

Class codes of employees:

Annual payroll per class code:

Attach copy of existing policy:

*Please note: if you leave this page before hitting submit, your form will not be saved.

Interested in other coverage options or a package discount?

Auto Insurance

Home Insurance

Life Insurance

Flood Insurance

Personal Umbrella Protection

Earthquake Insurance

CREATING PEACE OF MIND
SINCE 1964

Business Insurance Form

*Please note: if you leave this page before hitting submit, your form will not be saved.

Interested in other coverage options or a package discount?

CONTACT

Privacy Policy

SIGN UP

CREATING PEACE OF MIND SINCE 1964

Business Insurance Form

*Please note: if you leave this page before hitting submit, your form will not be saved.

Interested in other coverage options or a package discount?

CONTACT

Privacy Policy

SIGN UP

CREATING PEACE OF MIND
SINCE 1964