Business Information: |
Full Business Owner Name (First, Middle Initial, Last):
|
Business Name or DBA (doing business as):
|
Business Entity:
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Food Vehicle Type:
[Other] |
Square Footage of Vehicle:
[Other] |
Types of Food Cooked/Served:
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How Many Years in Business:
|
Physical Address Where Equipment & Contents Are Stored (P.O. Boxes Not Accepted):
City:
State:
Zip Code:
|
Phone Number [Required - We will ONLY call you if there is a problem with your information or to give you the quote]
(Our Promise: We will not solicit you or sell your phone number)
|
Where Should We Send the Quote?
[Email Required - We need this to email you the quote]
(Our Promise: We will not solicit you or sell your email address)
|
EIN (Federal Tax ID) or SSN (Your Privacy is Protected):
[to get you the best rate] |
|
Annual Gross Receipts
(estimate OK) |
Provide Values for Categories Below
(DO NOT include those values already shown above):
$
[Vendor Inventory (such as food or other items held for sale)]
$
[Supply Inventory (such as equipment, giveaways, paper goods)]
$
[Trailer Equipment (such as trailers, signs,
concession equipment, refrigerators, cooking equipment, supplies)]
$
[Portable Storage Units (not permanent structures)]
$
[Miscellaneous Equipment (please describe)] |
Do You Need Any Additional Insureds Certificates (If Applicable):
Yes
No
Additional Insured:
[Name]
[Address]
[Relationship; Owner/Lessor of Premises, Sponsor, Mortgagee, Other, Etc.]
Do You Need Any Evidence of Coverage Certificates (If Applicable):
Yes
No
Evidence of Coverage:
[Name]
[Address]
[Relationship; Owner/Lessor of Premises, Sponsor, Mortgagee, Other, Etc.] |
Additional Information: |
Additional Comments:
|
|
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