Craft Brewers Quote Get 10% off your business insurance premiums with our program designed specifically for you 1 Basic Information2 Insurance History3 Location 4 Operation Name of Brewery*Legal Name of BreweryName of Principal* First Last Phone*Email* Enter Email Confirm Email Website Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Is your mailing address the same as your operating address?*YESNOOperating Address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code do you currently have insurance?*YESNOPlease explain why you do not currently have insurancei.e - First time insuredName of current insurance companyCurrent Policy NumberCurrent PremiumPolicy Renewal Date Attach a copy of your current policy so we can compare coverage for a more accurate quoteAccepted file types: jpg, gif, png, pdf.Have you ever had insurance declined or cancelled by an insurance company?*YESNOPlease explain why your insurance was declined or cancelledHave you had any insurance claims in the past 5 years?*YESNOPlease list and explain all claims in the past 5 years Wall Construction*Concrete panels on steel structureFire resistiveFrame and all otherFloor Construction*Brick or stoneConcrete panels on steel structureFrame and all otherRoof Construction*Frame on steel joistsFrame on wood joistsHeavy beam or "mill"Poured concreteType of Heat*Central gas furnaceBoilerElectricOtherType of Electrical*BreakersFusesBreakers & fusesOtherIs there a sprinkler system?*YES - Full coverageYES - Partial coverageNONumber of stories (total for building)*Square Footage*Distance to Fire Hydrant*Within 150 metersWithin 300 metersOver 300 metersDistance to Fire Hall*Within 5kmWithin 8kmOver 8kmHow many years old is the building?*Please enter a value between 0 and 200.When was the last year the following were updated?HeatWiringRoofPlumbing Fire Alarm*YES - MonitoredYES - LocalNOBurglar Alarm*YES - MonitoredYES - LocalNO How many years have you been in business?*Gross Revenue (per year)*Any U.S or Foreign sales?*YESNOWhat % of total revenue is from U.S sales?Please enter a value between 0 and 100.What % of total revenue is from Foreign sales?Please enter a value between 0 and 100.