Fire Contractor Questionnaire

Business Name*

Business Physical Address*

City*

Phone

Email*

Do you have any engineers or architects on staff that design systems?YesNo

Are you an "Authorized Dealer" for any specific manufacture(s)?YesNo

If yes, please list names:

Are you a member of any trade organizations?YesNo

If yes, please list:

Please list the states in which you conduct business.

How many employees do you have?

How many vehicles do you have?

Fire Suppression Installation, Service & Repair

Restaurant Suppression Systems

Fire Extinguisher Services

Hood & Duct Cleaning

Fire Alarm Systems

All Other

What type of accounts do you service?
Office & RetailIndustrial & ManufacturingRestaurantsApartments & CondosHotels & MotelsHospitals & Nursing HomesOther

Are you a wholesale distributor of Fire & Safety Equipment?YesNo

If yes, what are your Annual Gross Sales?

Do you use subcontractors to do any work?YesNo

What is your Federal Id Number? (Needed for Workers Compensation quote)

What is the name of your current Insurance Company?

When does your current Insurance Policy Expire?

Have you had any Liability Claims in the past 5 years?YesNo

Please indicate the coverage's that you would like us to quoteGeneral LiabilityPropertyToolsCommercial AutoWorkers CompensationGroup Health Insurance