CALIFORNIA LICENSE # 0F89805
 
 
   
 
COMMERCIAL INSURANCE
 
LIQUOR STORES & GAS STATION INSURANCE QUOTE FORM
 
Full Name of Owner:
Address:
City:
State
ZIP:
Phone:
Cell Phone Business Phone
   
E-Mail Address:
   
  Current Insurance Details
   
Current Insurance Company:
Policy Number:
Any Claims:
What will be the Effective Date?
   
  Business Info.
   
No. of Years in Business:
Gross Sale:
Goods Sold:
Beer Wine Liquor Deli
Lotto Grocery Tobacco Fuel
   
Business Property Covered (BPP):
Liability Circle:
500/500 500/1000 1000/2000
Liquor Liability:
300/300 500/500 500/1000 1000/2000
Hours Open:
   
  Store Info.
   
Sign:
Glass:
Money Inside:
Employees:
Payroll:
   
  Property Info.
   
Building Square Feet:
Right and Left of Building:
Year Built:
Sprinkled / Non Sprinkled:
Bank / Landlord:
Social Security No.:
Fed Tax ID#:
   
  Security Info.
   
Central Alarm:
Fire Alarm:
   
     
 
 
 
 
 
 
 
 
 
 
 
Visit LIQUORSTOREGASSTATIONINSURANCE.COM for insurance services for Liquor Stores, Gas Stations, Workers Compensation & Liquor Liability Insurance.
 
LIQUORSTOREGASSTATIONINSURANCE.COM is wholly owned by Khalsa Insurance Agency, Inc.
 
GET INSURED TODAY, CALL US AT: 408.272.2500
 
CALIFORNIA LICENSE # 0F89805
 
SAN JOSE OFFICE
 
Khalsa Insurance Agency, 3750, Mckee Road Suite, A, San Jose, CA, 95127, United States of America.
 
T # 408.272.2500     |     F # 408.493.4552     |     Email:  info@khalsainsurance.com     |     View Directions
 

 
FRESNO OFFICE
 
Khalsa Insurance Agency, 2125 N Barton Av., Fresno, CA 93703, United States of America.
 
T # 408.272.2500     |     F # 408.493.4552     |     Email:  info@khalsainsurance.com
 
 

 
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