Forms pages 2

RIZO fillable Quote Information Sheet _ Commercial BOP

Free Text

Commercial General Liability Insurance Quote

Complete Business Name:

Date Business Started:

FEIN (EMPLOYER TAX ID #):

Address:

CITY, STATE, ZIP:

Contact Person Name:

Email:

Phone:

Website:

Detailed Description of Operations:

Annual Sales (anticipated next 12 months):

Owner Name(s):

Owner Annual Payroll:

# OF FULL TIME EMPLOYEES

& Annual Payroll

# OF PART TIME EMPLOYEES

& Annual Payroll

Dollar Amount Value of Business Property to Insure?

Description of Business Property to Insure:

TOTAL SQUARE FOOTAGE TO BE OCCUPIED:

If the building is older than 15 years, have THE ROOF, PLUMBING, ELECTRICAL, and HVAC been updated or replaced?

IS THERE A SPRINKLER SYSTEM INSTALLED?

What percentage of building?

Is there a monitored Burglar/Fire Alarm installed?

Monitoring Company:

Other personal forms below here

Rizo Ins _ Health Quote Info Request

Free Text

HEALTH INSURANCE INFORMATION SHEET

Name of Enrollee #1:

DOB:

Email:

Phone:

Mailing Address:

Enrollee's SSN:

US citizen:

Yes

If not, please confirm your immigration status below:

Enrollee’s income projection for the next calendar year:

Occupation:

Name of Employer:

Length of time at Employer:

Free Text

Note: If there are more dependents to list, please use the same template and complete the information until they are all listed.

Name of Enrollee #2:

DOB:

Email:

Phone:

Mailing address:

Enrollee’s SSN:

US citizen:

Yes

If not, please confirm your immigration status below:

Enrollee’s income projection for the next calendar year:

Occupation:

Name of Employer:

Length of time at Employer:

Free Text

Medical status of each Enrollee:

Free Text

Enrollee #1

Any medical conditions?

Any prescription medications?

Any doctor you’re requesting to see?

Free Text

Enrollee #2

Any medical conditions?

Any prescription medications?

Any doctor you’re requesting to see?

1380 Pantheon Way #200,

San Antonio, TX 78232

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RIZO fillable Quote Information Sheet _ Commercial BOP

Rizo Ins _ Health Quote Info Request

Lead Information Sheet - Auto & Home Ins

RIZO INS LIFE INS QUOTE FORM

1380 Pantheon Way #200,

San Antonio, TX 78232

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RIZO fillable Quote Information Sheet _ Commercial BOP

Rizo Ins _ Health Quote Info Request

Lead Information Sheet - Auto & Home Ins

RIZO INS LIFE INS QUOTE FORM

1380 Pantheon Way #200,

﻿San Antonio, TX 78232

San Antonio, TX 78232