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Business Owners (bop) Quote

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Business Owners (BOP) Quote Form

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Business Owners (BOP) Quote Questionnaire

Please complete the information below. IMPORTANT: This form is not an insurance policy – it is general information necessary to prepare a quotation. Note that many carriers require a complete signed carrier application specific to their product offerings.

General Information

Applicant Name:(Required)
Applicant Mailing Address:(Required)
"By submitting my phone number, I hereby authorize Cornerstone Agency Services, LLC to communicate with me through text messaging."
"By submitting my phone number, I hereby authorize Cornerstone Agency Services, LLC to communicate with me through text messaging."
Business Location Address (Leave blank if same as mailing address)
(Leave blank if same as mailing address)
Principal Contact Name (Leave blank if same as Applicant Name)
(Leave blank if same as Applicant Name)
(Leave blank if same as Applicant Name)
(Leave blank if same as Applicant Name)
Date Business Established
https://www.sec.gov/corpfin/division-of-corporation-finance-standard-industrial-classification-sic-code-list
Definition of Full-Time Employee For purposes of the employer shared responsibility provisions, a full-time employee is, for a calendar month, an employee employed on average at least 30 hours of service per week, or 130 hours of service per month. https://www.irs.gov/affordable-care-act/employers/identifying-full-time-employees
Definition of Part-Time Employee For purposes of the employer shared responsibility provisions, a part-time employee is, for a calendar month, an employee employed on average at less than 30 hours of service per week, or less than 130 hours of service per month.
Min. 10 Words):
Gross payroll is the total amount of money designated for a particular employee or for all employees in the business, depending on how the term is being used. The goal is to provide a maximum figure that can be easily examined by managers, payroll employees and analysts.
Annual revenue is gross revenue. That's all of a business's income generated from the sale of products or services, assets, and capital over 12 months before expenses are subtracted.
Insurance Coverage Requested (Check all that apply):(Required)
(Check all that apply):
Drop files here or
Max. file size: 1 MB.
    Please upload Current Carrier documents here.
    Current Policy Expiration Date:(Required)
    The expiration date refers to the day your insurance coverage ends, after which your policy is no longer in force, and you are no longer protected against potential risks or financial losses.
    Current Policy Retroactive Date:(Required)
    Your retroactive date is the date on which your coverage begins. It is usually the same as your inception date or the date since which you've held continuous insurance coverage.
    In insurance, policy limits are the maximum dollar amount that an insurer will pay for covered damages or losses under an insurance policy.
    Desired Effective Date for New Policy:(Required)
    You want your new policy to start the moment your old one expires, so your new policy needs an effective date that starts the day after the old policy's expiration date.
    In insurance, policy limits are the maximum dollar amount that an insurer will pay for covered damages or losses under an insurance policy.
    A deductible is your share of an insurance claim, which you must pay before your insurer provides financial coverage.
    We extend coverage to individuals and businesses in 
    Pennsylvania, New Jersey, and Florida.
    Toll Free - (888) 499-2762

    Direct to Branch Offices:
    Lancaster, PA (717) 898-5982
    Moorestown, NJ (856) 499-5191
    Elkins Park, PA (215) 298-9398
    Philly, PA (267) 678-1705
    Tampa, FL (813) 330-5707
    Mt Pleasant Mills, PA (570) 539–2758
    Garnet Valley, PA (484) 301-3292
    Altoona, PA (814) 979-1480
    Ebensburg, PA (814) 615-7992
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