BUSINESS INSURANCE QUESTIONAIRE
FIRST NAME 
LAST NAME C/O BUSINESS NAME
LAST NAME C/O BUSINESS NAMEPROPERTY ADDRESS
CITY STATE ZIP
STATE ZIPTYPE OF BUILDING INTEREST IN BUILDING AREA OCCUPIED (SQ. FT) DO YOU HAVE INSURANCE NOW?
INTEREST IN BUILDING AREA OCCUPIED (SQ. FT) DO YOU HAVE INSURANCE NOW?COVERAGE SECTION
LIMITS DESIRED FOR:
BUILDING
CONTENTS
LIABILITY
DISCOUNTS SECTON
CENTRAL STATION BURBLAR ALARM
CENTRAL STATION FIRE ALARM
STORM SHUTTERS
(MITIGATON INSPECTION REQUIRED FOR
SHUTTER CREDIT)
DATE OF SHUTTER INSTALL
AGE OF ROOF OR INSTALL DATE
DO YOU HAVE BUSINESS AUTO COVERAGE WITH
TRITON INSURANCE GROUP?
HAVE YOU HAD A WINDSTORM MITIGATION INSPECTION COMPLETED FOR YOUR HOME (FOR UP TO 45% IN DISCOUNTS)?
IF YOU HAVE NOT HAD AN INSPECTION, WOULD YOU LIKE US TO HAVE A MITIGATOR CONTACT YOU?
VERY IMPORTANT MONEY SAVINGS INFORMATION: Mitigation credits for Roof Installations under Miami Dade building codes 1994 and 2002 offer approximately 25% discounts with our Insurance Carriers (mandated by the state of Florida. Additionally the shutter and roof shape discounts, can offer another 23% in discounts. The standard cost of a mitigation inspection is $150.00.
CONTACT INFORMATION
HOME PHONE
CEL PHONE
FAX NUMBER
EMAIL ADDRESS:
GLASS COVERAGE?
SIGN COVERAGE?
TYPE OF WORK PERFORMED:
PROPERTY ADDRESS
