Texas CGL Form Texas Commercial General Liability Insurance for Texas Based Businesses Commercial General Liability Insurance Commercial Insurance Complete the following information if you would like to obtain a commercial Insurance quote. Remember, this is not an application, one will be sent to you if coverage is requested.All information provided on this information sheet is confidential and will be used solely for the purpose of quoting your commercial insurance. First Name: Last Name: Business Name County Street City State Zip Home Business What is your fax number? Fax What is your email address? Email Confirm your email address? Email What is the nature of your business? Nature of Business Is the business a corporation, partnership or sole proprietorship?CorporationPartnershipSole Proprietorship How many owners? Number of Owners: How many employees?:Number of Employees: What is the payroll amount of the owners? Payroll of Owners: What is the payroll amount of the employees? Payroll of Employees: What is the total annual gross? Total Annual Gross Receipts: What is the business license number? Business License Number: What is the license type? License Type Years of experience in this business?Years of Experience: How many years have you operated under your current business name? Years Operated Under Current Name: Have you used any other business names during the past 5 years? Other Business Names :YesNo Is this business open 24 hours a day Open 24 HoursYesNo Please describe the nature of your business and ANY unusual exposures. Unusual Exposures: Building & Property Information Year built: Total Square Footage of Business Building: Total Square Footage of Business Only: Square Footage of Customer Area: Stories:Select12 Ground Floor Square Footage: Losses - Claims: YesNo If yes, what is the date, amount paid and description of each loss or claim?: COVERAGE INFORMATION What is the current insurance company?: How much are you paying now? Amount Current Coverage: What is the liability limit requested? Liability Limit:Select$100,000$300,000$500,000$1,000,000 What is the building limit requested? If no coverage is required for your building - Please type in N/A or 0 Building Limit Do you require Coverage for the building? Yes/No What is the building deductible requested? Building Deductible:>Select$250$500$1,000$2,500 What is the business personal property (contents) limit requested? Business Personal Property: Do you require Coverage for the business personal property? Yes/No What is the contents deductible requested?:Contents DeductibleSelect$250$500$1,000$2,500 What is the loss of income requested?:Loss of Income Coverage Are there any questions, comments or additional coverage required?:Questions, Comments or Additional Coverage When is the best time to contact you:MorningAfternoonEveningAnytime I currently have insurance:YesNo Comments Comments are closed.