HomeNew Customer Application

New Customer Application

Contact Name(Required)
Mailing Address(Required)
MM slash DD slash YYYY
Type of Restaurant(Required)
Please check all that apply
Please List Location Address(es)(Required)
Please use the "+" and "-" buttons to add and remove locations to this list.
Location Name
Street 1
Street 2
City
State
Zipcode
 
Location Information(Required)
Please use the "+" and "-" buttons to add and remove locations to this list.
Location Name
Eat In Sales
Carry Out Sales
Delivery Sales
Alcohol Sales
Restaurant Hours
# of Employees
Seating Capacity
# of Servcers
 
Location Property Information
Please use the "+" and "-" buttons to add and remove locations to this list.
Location Name
Owner or Tenant
Building Value (if Owned)
Business Personal Property Limit
Tenant Betterments & Improvements
Standalone or Strip Mall
Sq Ft of Building
Sq Ft of Restaurant
 
Location Property Information - Continued(Required)
Building Type = Examples are Frame, Steel, Concrete, Brick, etc. **= If Year Built is Older than 1985, when was the last time a certified technician worked on or verified the working order / condition of the following... Also, Please use the "+" and "-" buttons to add and remove locations to this list.
Location Name
Roof Type
Year Built
Construction Type
Roof**
Plumbing**
Heating **
Electrical **
 
Do any of the locations have the following:
Please check all that apply.

General Operations

Are deliveries made?(Required)
Delivery associated with catering operations only(Required)
Delivery by employees?(Required)
Delivery by Employee-owned autos?(Required)
Delivery By Company-Owned Autos?(Required)
Delivery by Scooter/Moped/Bicycle?(Required)
Do you currently have a driver training course in place?(Required)
Do you guarantee delivery time?(Required)
Is valet parking service provided?(Required)
Delivery by third party vendor(s)?(Required)
If employees use their own vehicles on company business, does the Insured monitor evidence of personal auto insurance?(Required)
Are hold harmless agreements in applicant’s favor and Certificate of Insurance naming applicant as additional insured obtained for all independent contractors or vendors?(Required)
Do you provide off-site catering?(Required)
Catering Services include:(Required)
Are the applicant and all employees bonded for theft?(Required)
Are you interested in Employment Practices Liability?(Required)

Additional Coverages

Are you interested in Money and Securities Coverage?(Required)
Are you interested in Liquor Liability Coverage?(Required)
Are you interested in Workers Compensation Coverage?(Required)

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