Online Quote Form

Hotel Insurance Quote
Corporate Name:
DBA Hotel Name:
Contact Name:
Contact Email:
Contact Phone:
Tax ID Nmber:
Franchise ID Nmber:
Hotel Address 1:
Hotel Address 2:
City:
State:
Zip Code:
Hotel Fax:
Hotel Phone:
Number of Roooms:
Number of Stories:
Pool on Site:	Select... Yes No
Sprinkler System:	Select... Yes No Unsure
Monitored Alarm System:	Select... Yes No Unsure
Electronic Key Cards:	Select... Yes No Unsure
Type of Construction:	Select... Wood Frame with Brick or Stone Exterior Wood Frame with Stucco Exterior Metal Frame with Brick or Stone Exterior Concrete Block & Plank Unsure
Type of Roof:	Select... Composition Shingle Metal Tar & Gravel Rolled Composite Roof Clay Tile Other
Year Built:
Building Value:	$
Contents (FF&E) Value:	$
Annual Gross Sales:	$
How did you hear about us?	Select Referral Internet Search Google Yahoo Bing Flyer/Brochure Phone Book Radio Spot Other
Comments/Notes:
Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.

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