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Years of experience in this business
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Company operations:
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Residential work
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Commercial work
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Industrial work
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Commercial Insurance required:
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General Liability
Workers Comp
other
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Name of your company
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Owner(s) full name and DOB
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Business address
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Annual Revenue or for the next 12 months:
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Payroll for the next 12 months and how many employees (only w-2 employes):
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Payroll for the next 12 months and how many employees (only 1099 employes):
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Please list the states you work in
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Please select all that apply
Current commercial Insurance
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First time getting commercial insurance
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No commercial claims in the last 5 years
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Email
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Phone number
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395 Millard Farmer Ind Blvd, Ste C, Newnan, GA 30263
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