CL Renewal Form
" indicates required fields
Business Legal Name (and DBA, if applicable):
Address Line 2
District of Columbia
Northern Mariana Islands
U.S. Virgin Islands
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Are there any significant changes in your business operation since we last spoke? (Merger/Acquisition, New lines of business, new categories of operation, etc.)
How many W-2 employees does your team currently have?
What is your projected total W-2 payroll for the upcoming 12 months?
What is your projected gross revenue for the upcoming 12 months?
What is your projected total paid to subcontractors or 1099 team members for the upcoming 12 months? (if applicable)
If you have acquired any new property, added locations, or made other changes that effect your insurance needs, please detail them here.
We maintain an extensive network of local professionals to help our clients with many potential needs. Please check any box below for any service you'd like a personal introduction to one of our Channel Partners in that area.
Health or Life Insurance Agent
C.P.A. or Accountant
Attorney (all categories)
Commercial Real Estate Agent Commercial Property Manager
Hard / Private Money Lender Mortgage lender
Residential Real Estate Agent Residential Property Manager
Construction / Home Builder Handyman / Routine Housework Automobile Sales
Automobile Service / Repair
Heating and A/C Service / Repair
Pool Service / Repair
Pest Control / Exterminator
Physician (All Specialties)
Computer Service / Repair
Web Design / SEO Consulting
Do your renewal policies need to be submitted to L&I?
Do we need to add any additional insured's to your policy? (Bank, landlord, new contracts, etc)
My business is built on referrals. What businessowners do you know that could benefit from my help?
Is there anything else that we need to know now to make sure your insurance program is exactly what you need?
You may upload up to 3 files to us, if necessary.
Drop files here or
Max. file size: 100 MB, Max. files: 3.
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