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About Us
The KIS Team
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FAQs
Client Resources
Account Management/Claims
Life Insurance Questionnaire
Personal Insurance Questionnaire
Business Insurance Questionnaire
Renewal Questionnaire
Contact Us
Thoughtful Protection for Exceptional Assets
New Business Insurance Questionnaire
kisadmin
2026-06-11T14:30:17-06:00
Business Insurance Questionnaire
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Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Business Name/Named Insured
*
Title
DBA:
Business Address:
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Predominate operating state:
*
Do you operate in other states?
*
YES
NO
Please list all states:
Email
*
Phone
*
Website:
EIN:
*
Year Established:
*
Gross Annual Sales/Revenue:
*
Description of Operations:
*
Current Carrier Information
Carrier Name:
Policy Number:
Expiration Date:
Any Losses?
*
YES
NO
Loss Type:
Water
Wind
Hail
Injury
Other
Current limits:
*
$1 million
$1 million/$2 million
$2 million
$2 million/$2 million or higher
Employees
Number of full-time employees
*
0
1
2
3
4
5
6
7
8
9
10
Number of part-time employees
*
0
1
2
3
4
5
6
7
8
9
10
Total payroll:
Description of duties:
Business Auto
Does the business own an automobile?
*
YES
NO
Driver 1 (Name, DOB and Driver's License #):
Driver 2 (Name, DOB and Driver's License #):
Driver 3 (Name, DOB and Driver's License #):
Vehicle 1 (Year, Make Model, VIN):
Full Coverage?
YES
NO
Vehicle 2 (Year, Make Model, VIN):
Full Coverage?
YES
NO
Vehicle 3 (Year, Make Model, VIN):
Full Coverage?
YES
NO
Enroll in Telematics?
YES
NO
Hired/Non-Owned Auto Required?
YES
NO
Building
Building Type:
*
OWNER
TENANT
Are you the sole occupant of this building?”
*
YES
NO
Total Square Footage
Business Personal Property (contents)
Roof Type/Roof Year:
*
Year Built
*
Building Coverage:
Business Personal Property (contents):
Are there wiring, plumbing, or heating updates?
Construction type:
Frame—exterior walls of wood, brick veneer, stone veneer, wood ironclad, or stucco on wood
Joisted masonry—exterior walls of masonry material (adobe, brick, concrete, gypsum block, hollow concrete block, stone, tile, or similar materials)
Masonry noncombustible—same as joisted masonry except that the floors and roof are of metal or other noncombustible materials
Number of Stories:
Is There a Basement?
YES
NO
Workers Compensation
Owners Name, DOB, Last 4 digits of SSN:
Percent Owned:
Current Workers Comp Carrier:
Equipment
Amount of Unscheduled Equipment:
Description:
Scheduled Equipment #1 (Year, Make, Model, Serial #, Description, Date Purchased & Value):
Scheduled Equipment #2 (Year, Make, Model, Serial #, Description, Date Purchased & Value):
Scheduled Equipment #3 (Year, Make, Model, Serial #, Description, Date Purchased & Value):
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