EUROPEAN-AMERICAN INC.

COMMERCIAL PROPERTY Insurance Questionnaire
Please complete and return to EurAm
Company Name Street
Type of Applicant City
Telephone County
Telefax State / Zip
Website e-mail
  Federal Employer ID Number
How many years in business?
years
US Property Location #1 ( Full address)  
Street / Number
City / State
Zip / Country
Property Type Amount US $
Property Type Amount US $
Property Type Amount US $
Bldg=Building EDP=Electronic Data Processing & Equipment BPP=Business Personal Property
Description of Building:  
Age
Size (Sq. Feet)
Sprinklered
Distance to nearest fire hydrant
Occupancy / Usage
Type of construction
Valuation
ACV=Actual Cash Value RPLC=Replacement Value Valued=Mutually Agreed Valuation
Deductible $ other $
Personal Property (Full description of property stored)  
Coverage Required: ("All Risks", Named Perils, etc)
Additional Risk Information    
Is a formal safety program in operation?
Is there exposure to flammables, explosives, chemicals, or other hazardous materials?
Has coverage been denied, canceled, or non-renewed in prior 3 years? If yes please provide details.

 

US Property Location #2 - Please click here

 

Note: Completion of this application does not constitute a binder or obligate the applicant to purchase this insurance.

 

Desired Effective Date:    
Name: Title: Date: