Manufacturing Quote for Manufacturing Insurance Contact Person* Phone Number*E-mail Address* AddressAddress 2CityStateZipFaxYears in BusinessBuilding Square FeetOwn of Lease PremisesYesNoNumber of StoriesBasementYesNoConstruction Typemasonrymasonary n/cframeYear BuiltRoof type compositionShingleTileOtherRoof AgeIs there an automatic sprinkler systemYesNoWhat type of product do you manufactureClaims in last three yearsYesNoNumber of EmployeesTotal PayrollBankruptcies or Tx in past 5 yearsYesNoWhat types of alarms protect premisesDo you imported materials used in your production from other countriesYesNoDo you use materials that require special storage practicesYesNoIf Yes, explain your storage practicesAre you participating in the research & development of any new product or are you planning any new products for sale in the next 12 monthsYesNoThird ChoiceIf Yes, please explainDo you services repair products you did not manufactureYesNoDo you have a specific program to withdraw known or suspected defective productsYesNoHave any of your products been subject to voluntary recallYesNoPolicy Effective DatePolicy Renewal DateNumber of Vehicles to InsureApproximate Current PremiumCurrent Insurance Carrier