Business Insurance Application – Orr and Associates

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Business Insurance Application

Step 1 of 5

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Entry Date
Date Format: MM slash DD slash YYYY
Industry
Class
Controllling Agent
Name*
Business Name
Briefly describe your business operations.*

Location Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Email*

Annual Gross Sales (Estimated)*
Gross sales are the total amounts (before expenses) that a company earns and records from the sales of its products or services.
Entity Type*
Year Business Started*
Is this a home based business?*
- Yes
- No

Do you have any employees?*
- Yes
- No
Number of Employees*
Annual Employee Payroll (Estimated)*
Do not include payroll for owners, officers or partners.
Do you hire subcontractors?*
- Yes
- No

Please indicate quotes to include.
- General Liability
- Professional Liability
- Workers Compensation
- Commercial Auto
- Property

Orr & Associates Insurance Services BBB Business Review

Questions? Call 800-858-1315