Type of Establishment *
Select
Full Service Restaurant
Fast Casual
Quick Service / Fast Food
Fine Dining
Cafe / Coffee Shop
Bar / Tavern
Brewpub / Brewery
Wine Bar
Nightclub
Pizza Restaurant
Deli / Sandwich Shop
Bakery
Ice Cream / Frozen Yogurt
Food Truck
Catering Only
Ghost Kitchen / Virtual Kitchen
Buffet
Other
Cuisine Type
Select
American
Italian
Mexican
Chinese
Japanese / Sushi
Thai
Indian
Mediterranean
French
BBQ / Smokehouse
Seafood
Steakhouse
Vegetarian / Vegan
Farm-to-Table
Fusion
Other
Years in Business *
Select
New / Startup
Less than 1 year
1-2 years
3-5 years
6-10 years
11-20 years
20+ years
Entity Type
Select
Sole Proprietorship
LLC
Corporation
S-Corporation
Partnership
Franchise
Days Open Per Week
Select
5 days
6 days
7 days
Average Check Per Person
Select
Under $10
$10 - $20
$20 - $35
$35 - $50
$50 - $75
$75+
Do you serve alcohol? *
Select
No
Beer & Wine Only
Full Bar (Beer, Wine, Liquor)
Liquor License Type
Select
N/A - No Alcohol
Beer / Wine License
Full Liquor License
Restaurant Liquor License
Bar / Tavern License
Brewpub License
Catering License
Do you have a separate bar area?
Select
No
Yes
N/A - No Alcohol
Any liquor liability claims in past 5 years?
Select
No
Yes
N/A - No Alcohol
Building Construction Type
Select
Fire Resistive (concrete/steel)
Masonry / Brick
Frame / Wood
Mixed Construction
Unknown
Location Type
Select
Standalone Building
Strip Mall / Shopping Center
Downtown / Urban Storefront
Indoor Mall
Food Court
Hotel / Resort
Airport
Do drivers use personal vehicles for delivery?
Select
N/A - No Delivery
Yes - Personal Vehicles
No - Company Vehicles
Both
Any claims in past 5 years? *
Select
No claims
1-2 claims
3-5 claims
More than 5 claims
Coverage ever cancelled/non-renewed?
Select
No
Yes
Any health department violations in past 3 years?
Select
No
Minor violations (corrected)
Major violations
If claims occurred, please describe:
Preferred Contact Method
Select
Phone Call
Email
Text Message
Any method is fine
Best Time to Reach You
Select
Morning (before 11am)
Afternoon (2-5pm)
Evening (after 9pm)
Anytime
How did you hear about us?
Select
Google Search
Referral from another restaurant
Restaurant Association
Yelp / Google Reviews
Social Media
Existing Client
Other
Additional Comments or Questions