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Geri Custer
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Agent, Author, Television Personality, and Arizona Insurance Expert.
Please
E-Mail Me!
On-Line Restaurant
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Name/Restaurant Name:
Contact Phone Number:
Your E-Mail Address:
Confirm E-mail Address Again:
Street Address:
City:
State:
Zipcode:
Restaurant Type:
Choose One
Fine Dining
Casual
Pizza (Delivery)
Pizza (No Delivery)
Fast Food
Bar / Tavern (Food)
Bar / Tavern (No Food)
Nightclub (Live Entertainment)
Nightclub (No Entertainment)
Gentlemen's Club
Other
Current Insurance Company:
Renewal Date:
Current Cost:
Any Claims in the Last 3 Years?
Choose One
Yes
No
Liquor Liability Included in Current Coverage?
Choose One
Yes
No
Building Coverage:
Choose One
Own the Building
Do NOT Own the Building
Age of Building:
Business Property Amount:
Ansul Type:
Deductible:
Catering?
Choose One
Yes
No
Patio?
Choose One
Yes
No
Live Music?
Choose One
Yes
No
DJ?
Choose One
Yes
No
Total Square Footage:
Public Access Sq. Ft.:
Approximate Gross Sales:
Food Sale %:
Alcohol Sale %:
Number of Employees:
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