Commercial Insurance Questionnaire | Commercial Insurance Programs by Ideal Insurance Agency Inc

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Commercial Insurance Questionnaire

Commercial Insurance

We work with over 40 carriers offering business insurance programs and many additional brokers giving us access to hundreds of more carriers.

The questionnaire is extensive and includes many questions to find as many discounts and affinity programs as possible to fine the best fit.

A group of business people standing around a puzzle piece.

Commercial Insurance Questionnaire

"*" indicates required fields

Step 1 of 10 - Contact Information

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Contact Information

Let us know who we should communicate with to create proposals for you.

Contact First Name

Contact Last Name

Business Name (if no Business name, use Personal Full Name)*

Contact Title

Contact Phone*

Email*

Fax

Business Information

Most insurance policies will base the premium charged on size, owner experience, type of business and types clientele working with. Many carriers have deep discounts for favorable aspects of the business.

What is Business Type (Contractor, Store, Inspector, etc.)

Contractor

Retail Store

Inspector

Home Health Care Services

Other

If Other, What is the business type

Business Description (Summary, daily acitivities, etc.)

Years of Experience in Trade

None

1 Year

2 Years

3 Years

4 Years

5 Years

Other

If Other, Years of experience in trade

Owner Information Information

Owner First and Last Name

First Last

Primary Owner's highest level of education obtained (Discounts Available)

High School (GED)

Some College

College Degree

Masters

PHD

Other

If Other, Primary Owners highest level of education

Owner Phone

Owner Phone 2nd

Owner Cell Phone

Owner Business Phone

Owner Email

Owner Email 2nd

Your company Website

Owner Date of Birth

Month

Day

Year

Owner Drivers License Number

Owner Social Security Number

Owner Fax Number

How many Owners

1 Owner

2 Owners

3 Owners

4 Owners

Other

If Other, Number of owners

Additional Owners - (List Names, DOBs, DLs, SSs, etc.)

Most carriers will want a physical address, so if you use a PO Box the carrier will need physical address also.

Addresses

Mailing Address

Street Address Address Line 2 City State ZIP Code

Mailing County

Premises Address same as Mailing Address

Yes

No

Premises Location / Premises Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Location / Premises Address County

Most carriers will use this data to qualify for which program is the best fit for the business. The more accurate this information we receive the more complete of proposal that can be created.

Business Operations

In Business Since (Year)

2026

2025

2024

2023

2022

2021

2020

2019

2018

2017

2016

Other

If Other, Year business started

Is your business a New Venture

Yes

No

Insurance Types Needed

General Liability

Workers Compensation

Auto Insurance

Property Insurance

Employee Benefits

Bond

Health

Life

Equipment

Professional Liability

Flood

Liquor Liability

Umbrella

Other

If Other, Insurance Types Needed

Business Structure (S-Corp, LLC, individual, etc.)

Individual

LLC

S-Corp

C-Corp

Non-Profit

Other

If Other, Business Structure

Federal Tax ID Number

State Unemployment ID Number (if known)

Number of Full Time Employees

No Full Time Employees

1 Full Time Employee

2 Full Time Employees

3 Full Time Employees

4 Full Time Employees

Other

If Other, Number of full time employees

Number of Part Time Employees

No Part Time Employees

1 Part Time Employee

2 Part Time Employees

3 Part Time Employees

4 Part Time Employees

Other

If Other, Number of part time employees

Number of Volunteers

No Volunteers

1 Volunteer

2 Volunteers

3 Volunteers

4 Volunteers

Other

If Other, Number of Volunteers

Estimated Amount Paid to Subcontractors next 12 months

Nothing Paid to Subcontractors

$5,000 paid to Subcontractors

$10,000 paid to Subcontractors

$25,000 paid to Subcontractors

$50,000 paid to Subcontractors

$100,000 paid to Subcontractors

Other

If Other, estimated amount paid to subcontractors

Estimated Amount of revenue (gross amount to earn) next 12 months

None

$25,000 of Revenue

$50,000 of Revenue

$75,000 of Revenue

$100,000 of Revenue

$150,000 of Revenue

Other

If Other, Estimated amount of revenue

Amount of revenue (gross amount earned) Last 12 months

None

$25,000 of Revenue

$50,000 of Revenue

$75,000 of Revenue

$100,000 of Revenue

$150,000 of Revenue

Other

If Other, Amount of revenue

Estimated Total Annual Payroll (Paid to employees excluding Owners for year)

None

$25,000 of Payroll

$50,000 of Payroll

$75,000 of Payroll

$100,000 of Payroll

$150,000 of Payroll

Other

If Other, Estimated total annual payroll

Total Annual Payroll (Paid to employees excluding Owners last year)

None

$25,000 of Payroll

$50,000 of Payroll

$75,000 of Payroll

$100,000 of Payroll

$150,000 of Payroll

Other

If Other, total annual payroll last year

Equipment Coverage

Equipment can be insured and listed (Scheduled) individually or can be an amount to multiple unlisted (unscheduled) equipment .

Equipment Coverage Amount (If needing coverage)

No coverage for Equipment

$3,000 of Equipment

$5,000 of Equipment

$10,000 of Equipment

$25,000 of Equipment

$50,000 of Equipment

$75,000 of Equipment

Other

If Other, Equipment coverage amount

Equipment Description (Type, Value of each item, Serial #s, etc.)

Prior / Current Insurance

Do you have previous insurance?

Yes

No

Insurance Company Name

Insurance Expiration Date

Month

Day

Year

Additional Owners

Additional Owners - List Names, DOBs, DLs, SSs, etc

Questionnaire

To expedite receiving proposals you can complete additional questions depending on insurance types you have selected.

Complete additional questions to speed up proposals and find most competitive pricing.

No

Yes

General Liability

Workers Compensation

Auto Insurance

Property Insurance

Bond - Surety or Others

Professional Liability

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