In-Home Business Insurance Inquiry
Insurance for your home based business......
PENNSYLVANIA
Please complete the information below for a no obligation quote....
Company Name:
Contact Person:
Address:
City, St., Zip:
County:
Phone Numbers:
E-Mail Address:
Type: What does your business do?
BUILDING INFORMATION
Dwelling Construction......
Your interest in Premises
Occupancy..................... 		Frame
Own
Single Family 		Masonry
Rent
Multiple Family
BASIC BUSINESS INFORMATION
Year Started
Annual Sales
Payroll
$
$
Coverages....
Business Personal Property: (100% Replacement Cost) $ ($ 5,000 Minimum & included with policy)
Computer Hardware & Software: (optional) $
Money & Securities: (Optional)
Liability Limit:
Garage Keepers (for garage operations only)
If you operate a auto garage operation, you can select Garagekeepers Coverage on your customer's vehicles
As part of your operations, what is the greatest number of vehicles in your care, custody and control at any one time?
One Vehicle (Garagekeepers Limit: $30,000 or $ 60,000
Two to Four Vehicles ($60,000 Limit is Mandatory)
More than Four Vehicles		 Select Coverage Option
Legal Liability
Direct Coverage (Primary Basis without regard to legal liability)
Direct Coverage (Excess over customer's policy without regard to legal liability)
Additional Insured/Loss Payee Information
Controlling Interest in this business
Co-Owner of Insured Premises
Manager or Lessor of Premises
Lessor of Leased Equipment
Owner or Lessor of Leased Land
Grantor of Franchise
State/Political Subdivision (for permits relating to the premises)
Name:
Address:
City:
State:
Zipcode:
Loss Payee
Name:
Address:
City:
State:
Zipcode:
General Underwriting Information..
Is your business property permanently kept anywhere other than this residence (residence includes outbuildings within 100ft)? Yes / No
Have you had more than two claims of any type, related to your business operation, in the past three years? Yes / No
Have you had a single claim, related to your business, for more than $25,000 in the last three years? Yes / No
Do you own any business under the same legal name as the "Business Name" shown, which is operated at a different location? Yes / No
Do you repackage food or personal care products to be sold under your own label? Yes / No
Are you involved in the sale or manufacturing of explosives, propellants and/or use of flammable liquids? Yes / No
Do you install any products, excluding the installation of computer systems, office equipment, key-locking devices, interior window treatments or vinyl signs and lettering? Yes / No
During the last five years, has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or any other arson-related crime in connection with this or any other property? Yes / No
Did your gross annual sales/receipts from your business pursuits for the most recent calendar year exceed $250,000 for sale of merchandise or $500,000 for a service business? Yes / No
Do you employ more than ten (10) employees, other than independent contractors or distributors? Yes / No
Is your dwelling located within 1,500 feet from the seacoast on the Gulf of Mexico or the Atlantic Ocean? Yes / No
If you are a teacher/tutor (other than a personal fitness trainer), do you provide instruction for sports, physical education, industrial arts, or martial arts? Yes / No
Do you perform any vehicle repair services (other than oil changes, oil filter changes, glass repair, interior detailing or vinyl/leather repair)? Yes / No
Do you perform any of the following?
  • Body Massage (other than face, scalp or hand)
  • Hair Straightening by other than cold process
  • Tanning
  • Microdermabrasion
    		•
  • Acid Peels
  • Hair Replacement
  • Hair Removal (by electrolysis, thermolysis, or any process using radio waves)
  • Ear Candling
    •
  • Tattooning or Permanent Make-Up
  • Ear or Body Piercing
  • Hydrotherapy/Saunas
  • Body Waxing (other than facials)
    		•
    		Yes / No
    Do you own or operate any other business under this entity that has not already been described on this site? Yes / No
    Are you an importer of foreign products? Yes / No
    M c G R A T H   I N S U R A N C E   G R O U P

    4170 William Penn Highway      Murrysville, PA. 15668-1890
    (724) 327-8474      Toll Free: 1-800-977-2999