Liquor Liability Quote Form

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Company Information

Company Name *

Street *

City *

State *

ZIP / Postal Code *

Primary Phone Number *

Alternate Phone Number

E-Mail Address *

Company Owner

First Name *

Last Name *

Nature of Business

Number of Owners

Gross Annual Sales

Number of Employees

Annual Employee Payroll

Subcontractors Used

Annual Cost of Subcontractors

Square Footage of Location

Additional Information

Prior Insurance

Length of Coverage (Months and Years)

Number of Additional Insureds Needed

How did you hear about us?

Important Notice:

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Schwab Insurance Agency, Inc
4794 Industrial Dr.
Millington, MI 48746
Phone: (989) 871-4505
Fax: (989) 871-5505
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