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Joe Bill Mettauer Insurance Agency

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Name *

Email *

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Address *

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Zip *

Interested In *

Business Owner's Policy Commercial Liability Policy Artisan Contractor Policy Commercial Auto Policy Surety Bond Other

Check all that apply.

Currently Insured? *

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Name of Insurance Carrier *

How Long Insured With Them? *

Any Claims Last 5 Years *

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Proposed Effective Date *

Your Business

Business Name or DBA *

Address (if different than above) *

Number of Years in Business *

Company Type *

EIN *

Number of Owners, Members or Officers *

Annual Gross Receipts *

Annual Payroll *

Number of Employees *

Describe Your Business *

Your Operations

Day to Day Operations *

Retail Wholesale Restaurant Contractor Construction - Residential Construction - Commercial Delivery Trucking Charitable Organization Other - explain below

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More about your operations *

If contractor, years experience *

Percentage of work residential *

Percentage of work commercial *

Your Property

Type of Property *

Square Feet *

Value of Business Property *

Year Building Built *

Building Construction Type *

Occupancy Type *

Value of Building (if you are the owner) *

Protection Devices (check all that apply) *

Smoke Detector Burglar Alarm Fire Sprinklers Fire Alarms Fire Extinguishers Deadbolts Monitored Security System

Your Vehicles

Number of company vehicles *

Describe types of vehicles *

Describe vehicle operations *

Trucking, construction, retail or wholesale delivery, contractor vehicle, etc.

Radius of operation *

Less than 50 miles 51-100 miles Over The Road Interstate

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Additional Comments

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Joe Bill Mettauer Agency
Phone: (936) 598-5516
Toll-free: (800) 259-7952
Fax: (936) 598-8943
1007 Tenaha Street
Center, TX 75935
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