CREATING PEACE OF MIND
SINCE 1964

Important: Please Complete the Form in One Sitting

This form cannot be saved and completed at a later time. Please make sure you have enough time to complete all required fields before you begin. Your progress will not be saved if you leave the form before submitting it.

Business Insurance Form

First name:

Last name:

Email:

Phone:

Business name:

Description of operations:

Years in business:

FEIN:

Annual sales:

Physical address of business:

List additional locations (address) here:

Building Information

Address:

Total Building Area:

Year Roof Upgraded:

Year Electrical Upgraded:

Year HVAC Upgraded:

Year Plumbing Upgraded:

Do you have any special equipment or business personal property:

Yes

If Yes, Description and value:

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

Workers Compensation Insurance

Number of full time employees:

Number of part time employees:

Classification Codes:

Annual payroll per class code:

Attach copy of existing policy:

Who referred you to Santa Cruz Insurance?:

Name of referral:

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

Important: Please Complete the Form in One Sitting

Business Insurance Form

Interested in other coverage options or a package discount?

CONTACT

Privacy Policy

SIGN UP

CREATING PEACE OF MIND SINCE 1964

Important: Please Complete the Form in One Sitting

Business Insurance Form

Interested in other coverage options or a package discount?

CONTACT

Privacy Policy

SIGN UP

CREATING PEACE OF MIND
SINCE 1964