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Wireless Giant Form
Wireless Giant Form
Wireless GIANT Franchise Insurance
Company Name (DBA)
Contact
If this is a coastal state - How many miles is your location from the ocean?
Phone
Fax
Effective Date
Website Address
Property Deductible
Contents Limit
County
Sprinklered?
Yes
No
# of Stores
Building
Sole Occupant
Multiple Tenants
Construction Type
Frame
Joisted Masonry
Non-Combustible
Masonry Non-Combustible
Fire Resistive
Sq. Footage
Year Built
Year of Updates to Roof
Year of Updates to Electrical
GL Limits
Gross Sales
Additional Insured
Yes
No
If Yes, Complete Name and Address
Losses?
Yes
No
If Yes, Please provide details below
date of loss, description of loss, amount of claim
Years in Business
Years of Experience
Type of Entity
Corp.
LLC
Individual
Partnership
Other:
Owned Autos?
Yes
No
Hired/Non-Owned Liability Needed
Yes
No
Umbrella
Yes
No
If Yes, Limit?
Employees
Number of Full-Time
Number of Part-Time
Total on Payroll
Comments
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