Robinson Insurance - Focusing our resources to focus on our clients' business.   Please use this form to apply for a quote. We will respond to your request by the next business day. Thank you!   *Indicates a required field. *Company Name:   *Street Address:   *City:      State: TX *Zipcode:     Company Website:   Year Founded:   Federal Tax ID:   Type of Entity:   Choose Sole Proprietorship Partnership Corporation Limited Liability Partnership Limited Liability Company Bulding Owner Full-Time Employees:   Part-Time Employees:   *Projected Annual Revenues:   *Projected Annual Payroll:   Type of Business:   Choose Retail Wholesale Service Office Habitational Bulding Owner Description of Business:   Primary Customers:       *First Name:   Middle Initial:   *Last Name:   *Email Address:   *Business Phone:    Extension Business Fax:   (ex.999.222.2222)     Interest in Building:   Choose Tenant Owner Lessor Construction Type:   Choose Wood Frame Concrete Tilt-Up Masonry Steel Frame Other Year Built:   Basement?     Yes     No Sprinklers?     Yes     No Burglar Alarm Type:   None Local Central Station Square Footage:       Building:   Tenant Improvements:   Business Personal Property:   Computer Equipment:   Loss of Income:   Extra Expense:   Valuable Papers and Records:   Property at Tradeshows:   Transit Coverage:   Employee Dishonesty:   Depositors Forgery:   Do you have other locations or buildings?     Yes     No     First Name:   Last Name:   Date of Birth:   Title:   Percent of Ownership:       First Name:   Last Name:   Date of Birth:   Title:   Percent of Ownership:     There are more owners:       Do you have foreign locations?     Yes     No   Do employees travel out of state?     Yes     No   Do employees travel out of the country?     Yes     No   Are there any dependent business premises (e.g. a single location supplier)?     Yes     No   Is electronic data processing errors and omissions coverage needed?     Yes     No   Do you have franchised locations?     Yes     No   Is electronic data processing errors and omissions coverage needed?     Yes     No   Do you have high-profile directors?     Yes     No   Is directors and officers coverage desired?     Yes     No   Is employment practices liability coverage desired?     Yes     No   Is boiler and machinery coverage required?     Yes     No   Owned autos?     Yes     No   If yes, list make, model, VIN, cost new, drivers, birthdates, and driver's licenses:     Are employee health plans provided?     Yes     No   Is a 401(k) plan provided?     Yes     No   Is an ERISA Bond needed?     Yes     No   Is computer fraud coverage needed?     Yes     No   Is kidnap and ransom needed?     Yes     No   Is life insurance for buy/sell needed?     Yes     No   Is key person life needed?     Yes     No   Is non-qualified deferred compensation needed?     Yes     No   Is workers' compensation needed?     Yes     No   Is key person life needed?     Yes     No   Are you a subsidiary of another entity or do you have any subsidiaries?     Yes     No   Any exposure to flammables, explosives, or chemicals?     Yes     No   Do you install, service, or demonstrate products?     Yes     No   Are foreign products sold, distributed, or used as components?     Yes     No   Do you sell guarantees, warranties, or hold harmless agreements?     Yes     No   Are you involved with products related to the aircraft or space industry?     Yes     No If you answered yes to any of these questions, please explain:       Current Insurance Company:   Expiration Date:   Who provides your legal assistance?   Who is your CPA?   Who do you bank with?   Who provides your Payroll service?       Site Contents Copyright 2002, Robinson Insurance. Site design & maintenace by TWG Interactive.