Association Insurance Programs - acc quote request form

Craft Council Business Insurance Quote Request

Thank you for completing the quote request form. We will be in contact with you as soon as possible.

Are you a Craft Council member?

Contact Name:
BusinessName:
Address:
City:
State:
Zip Code:
Phone:
Email Address:
Website:
Tax ID:
Business Entity Type:

Does your business currently have insurance?

If yes name of carrier:
Types of current insurance coverage:
Years of industry experience:
Year business started:
Description of business operations:
Gross Annual Receipts:
Any Claims or Losses against the business in the last 5 years?

If Yes Please Describe:
Liability Limits desired:

Do you teach classes?

If yes how many students per year?
Square feet of shop or studio:
Do you lease or own the space your office is in?

If owned please list the replacement cost value:
Type of construction:

If other please describe:
Year built:
Alarm System:

Sprinkler System:

Smoke Detectors:

Value of your studio equipment:
Value of the stock / inventory:
Do you use tools away from your studio?

If yes what is the total value of your tools?
Do you ship items to your clients?

Average value shipped:
Do you have a booth at trade shows or exhibitions?

If yes average number of events per year:
If yes please list the average value of merchandise:
Do you have vehicles titled to or leased in the name of your company to be insured?

If yes list make model VIN # Deductible:
Workers Compensation:
Number of employees & total payroll:
Number of owners / officers & total payroll:

Comments:
Do not enter anything in this field: