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Beauty Salon Insurance Application
Please enter numbers without commas
* Required Fields


Contact Person

First Name *
 		Last Name *
Home Phone
 		Home Fax
 		E-Mail *
 

Mailing Address (Only if different than business location)

Street Address
City
State
Zip
-
 

Business Information

Name *
 		DBA
Street Address *
City *
 		State *
 		Zip *
 -
Phone *
 		Fax
 

Beauty Salon Insurance Information

Current Carrier
 Expiration Date (mmyy)
Losses Last 3 Years
Years In Business
 Gross Reciepts
$ 		Annual Payroll
$
Total Sq. Ft. Occupied
 Number Of Stories
 Year Built
Type of Construction:
Frame   Brick   Non-Com 		Alarm
Sprinklered 		Updated
 Year
Building Limit
$ 		Contents Limit
$ 		Earnings Limit
$
Signs
 Glass
Do you use or sell products under your own lables?   Yes   No
Do you operate a botique?   Yes   No
Number of operators (including independant contractors) that provide the following:
Full Time Part Time Full Time Part Time
Hair Work Facials
Waxing Nails
Massage Electrology
Perm. Makeup


Notes

 




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