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Welcome to Mullen Insurance Agency Inc.

 

When you are ready to bind coverage, we can email you the correct applications.  We can accept payments by email or fax, using our Fax Authorization Form.  

Commercial Property

Quick Quote Sheet
.

Applicant Information   

I am:    Agency Name:     

                                   Producer Name:

             required!         Email Address:      (retail customer or agent)

Customer  Information       
DBA: Name: 
Location

Address:

 Phone:
City: Fax:
County:    
State: Only available in Texas.
Zip:

Operations Information    

Complete one quick quote sheet for each building.

Location #     Building #
Building is specifically used for:

If office, what type of business:

 Year Built  
If older than 15 years, when were updates done to: Roof           Electrical    Plumbing
Construction Type: If brick, Brick Veneer or Brick Masonry?
Square Footage: How many stories?  
Fire Protection

 

 How many feet to the nearest fire hydrant?           

How many miles to the nearest fire department?

Please check all that apply: Monitored Alarm      Smoke Alarm       Fire Extinguishers 
Burglar Bars       Inside Sprinkler System        Completely Fenced   
other                describe: 
 Years   Owned    OR   Years Leased # of Years Experience
If a Restaurant: Is a working automatic fire extinguishing system (Ansul System) over all cooking equipment with a maintenance contract?

 
If Apartments, Dwellings or Condos:               Habitational Questionnaire must be submitted

              (Link below)
If a Convenience/Grocery Store:

 

 gas station?                     Car Wash?   

 # pumps                       Days & Hours of Operations:

If an Auto Repair Shop:

 

 

 Spray Painting?    

OSHA approved booth?

Inside Welding?   

What percent?   

Does welding meet OSHA requirements?

 
If a Motel/Hotel: How many units?

Is there a swimming pool?

 

 Is there a restaurant?

What is the nightly rate?

 

Coverages                                                     
Type Coverage Requested        and 

Include Theft? 

   (Theft with monitored alarm only)        
Building Amount:
Contents Amount:
Other: Sign $  Gas Pumps $   Canopy $   

Fence $      Loss of Income $

3-Year Prior Carrier and Loss History 

if no losses, say NONE or NA
  Carrier Loss amount, date & description 
Expiring
1st Prior
2nd Prior

If you do not have 3 years prior coverage:

Please give info/loss history on any other current or prior location:

If no prior coverage, describe your prior experience:

Need a habitational questionnaire supplement?  

Additional Information
Need A Fax Check Form?

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