Health Food Store Insurance Quote

Business Name:
Premises Address:
City:     State:     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)
Website Address:
Description of Operations or SIC code:

Current Insurance Company:
Policy Expiration Date:          (mm/dd/yyyy)

Please Quote: (check as many boxes as desired)
Package
Workers Compensation Insurance
Business Owners Insurance
Directors & Officers Insurance
Business Umbrella Insurance

             Property Contents
Full replacement value of inventory, including fixtures: $
Square footage you occupy:
Building Limit (if you own the building) $

Type of Construction:

Sprinkler system in your building?
Burglar Alarm:        Central Station Alarm:
Total Annual Sales: $
Is your store located within 5 miles of any coastline?

             Workers Compensation
Class                         Code           Total Payroll
Store Employees:            $
Clerical Employees:     8810         $

Experience Mod (if any, per policy)
Federal Employer's ID #

Umbrella Insurance Amount Desired:

Additional Information

Click on the "Submit Quote Information" button below
to send your insurance quote request.

We are licensed in all of the states listed below and offer an exclusive
insurance program designed specifically for Health Food Store and
Vitamin Store businesses.

In addition to a Business Owner, Directors & Officers, Business
Umbrella, or Workers Compensation Insurance Quote, we can
also offer your Health Food Store or Vitamin Store business
affordable Group Health Insurance premiums.

Health Food Store

Insurance Quote

"Your Health Food Store & Vitamin Store insurance specialist!"

Privacy

Legal

Business Information:

Information received from this Health Food Store or Vitamin Store insurance quote
form sent to Kapatoes Insurance Services will be for our use only and will not be sold,
given to or distributed to any other parties. A quote will be based on the insurance
information provided and does not guarantee acceptance of the risk by us. The
precise coverage afforded is subject to meeting underwriting guidelines, and the
terms, conditions and exclusions of the policy as issued. By submitting this request
you acknowledge that this is neither an offer to insure nor a guarantee of insurance.
Completion of this form does not entitle you to Health Food Store or Vitamin Store
insurance.