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New Customer Application

  • Date Format: MM slash DD slash YYYY
  • Please check all that apply
  • Please use the "+" and "-" buttons to add and remove locations to this list.
    Location NameStreet 1Street 2CityStateZipcode 
  • Please use the "+" and "-" buttons to add and remove locations to this list.
    Location NameEat In SalesCarry Out SalesDelivery SalesAlcohol SalesRestaurant Hours# of EmployeesSeating Capacity# of Servcers 
  • Please use the "+" and "-" buttons to add and remove locations to this list.
    Location NameOwner or TenantBuilding Value (if Owned)Business Personal Property LimitTenant Betterments & ImprovementsStandalone or Strip MallSq Ft of BuildingSq Ft of Restaurant 
  • 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 NameRoof TypeYear BuiltConstruction TypeRoof **Plumbing **Heating **Electrical ** 
    Please check all that apply.
  • Please also describe the type of play area for each location.
  • Contents

    • 1 General Operations
    • 2 Additional Coverages
    • 3 Money and Securities
    • 4 Liquor Liability
    • 5 Workers Compensation
    • 6 Kitchen Facilities
    • 7 Expiring Coverage Information
    • 8 Signature

    General Operations

  • Date Format: MM slash DD slash YYYY
  • Additional Coverages

  • Money and Securities

  • Liquor Liability

  • Workers Compensation

    # FT EEs # PT EEs FEIN (federal employment identification number) Estimated Annual Restaurant Payroll Estimated Annual Delivery Payroll
  • Kitchen Facilities

  • Expiring Coverage Information

  • CarrierPolicy #Exp. DatePremium 
  • CarrierPolicy #Exp. DatePremium 
  • Expiring Total SalesExpiring Eat-In SalesExpiring Alcohol SalesExpiring Delivery SalesExpiring Carry Out Sales 
  • Signature

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643 Bair Island Rd
Suite 402
Redwood City, CA 94063

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  • Pizzasurance Online
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Legal

CA DOI Lic #: 0H58337

Copyright © 2015-2016, Stratton Agency. All rights reserved.

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License.

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  • Software
    • Pizzasurance Online
    • StratTrax Driver Compliance
    • Logins
      • Pizzasurance Online
      • StratTrax
  • Services
    • Compliance
      • Strattrax Driver Insurance Compliance
      • Corporate Certificate Compliance
    • Other Services
      • Human Resources
      • Payroll
    • Insurance
      • Benefits
      • Business Auto
      • Business Owners
      • Cyber Liability
      • Employment Practices
      • Excess Liability
      • Non-Owned Auto
      • Workers Compensation
  • Customers
    • Prospective Clients
      • Pizza & Delivery
      • Franchises
      • New Customer Application
    • Current Clients
      • Pizzasurance Online Login
      • StratTrax Login
    • Service Center
      • Update Driver Info
      • Add New Location
      • Submit A New Vehicle
      • Submit a New Driver
      • Builders Risk Application
      • New Customer Application
      • Auto Claim Form
      • Property Claim Form
  • Resources
    • New Customer Application
    • About
    • Blog
    • Contact
    • FAQs
    • Newsletters
    • Partners
    • Videos
  • (888) 888-4501
  • Request Demo