West Insurance Group New Business Prospects Commercial Lines Questionnaire

	Name:		Phone Number:
	Name of Business:		Type of Business:
	Location of Business:		Number of years in business :
	Email Address
Type of insurance needed:   Insurance Products: Please Select Property General Liability Business Income Commercial / Auto Builders Risk and OCP Boiler and Machinery Workers Compensation Employee Benefits Professional Liability Directors and Officers Liability Errors and Omissions Liability Employment Practices Liability Directors and Officers Liability Errors and Omissions Liability Employment Practices Liability Fidelity Bonds Performance Bonds Umbrella Liability Group Life and Health Personal Life Insurance Personal Life Insurance 401 K and Employee Benefits   Insurance Services: Please Select Brokerage Services Risk Management Loss Control Replacement Cost Evaluation Underwriting Claims Management Oversight Safety Incentive Programs Program Creation and Management Benefit Analysis   Comments: