Texaspartnersinsurance

General Information

Name of Business

Contact Name

Mailing Address

City

State

Zip

Business Phone

Best Time To Call

FAX

Contact Email Address

About Your Business

Location Address (if different)

City

State

Zip

years How Long At This Location

years Years In Business

Name on License

Effective Date Requested

Expiration Date

TYPE OF OPERATIONS

Select All That Apply

Tavern or bar without entertainment and annual alcohol beverage receipts over $250,000.

Tavern or bar with entertainment nightclub.

Tavern or bar without entertainment and annual alcohol receipts under $250,000.

Restaurant (over 50% food), hotel, motel, or private club that serves food.

Private Club (no food).

Package liquor store, convenience store or gas station.

Manufacturer, wholesaler, or distributor.

Special event (include supplemental application).

Other (describe in detail below).

Miscellaneous Information

Do you dispense or provide alcoholic beverages for any events off-premises?:

Yes

Number of the person who keeps the books

Phone

Sales Information

Past 12 Months

Next 12 Months

Estimated Sales

Gross Sales others

Gross Alcohol sales

Coverage Information

$ Primary Limits Desired

$ Each Common Cause

$ Aggregate

$ Prior Policy Limits

Previous Coverage Information

Previous Liquor Liability Carrier

$ Premium

$ Limits

Policy Number

Effective Dates

General Information

Number of employees (per shift)

First Sihft

Second Sihft

Third Sihft

Number of bouncers / security

Bouncers

Security

Current / Previous Insuror

Current/Previous Insurance Company

Policy Number

Expiry Number

$ Premium Package Policy

$ Limits

In General Liability Coverage Carried

Yes

Applicant ever had insurance cancelled or non-renewed

Yes

If yes, please provide detals below

Applicant of any other owner, partner or licensee ever had a liquor license revoked or suspended

Yes

If yes, please provide detals below

Additional Information

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Texas Liquor Liability Online Insurance Quotes

General Information

About Your Business

TYPE OF OPERATIONS

Select All That Apply

Miscellaneous Information

Sales Information

Coverage Information

Previous Coverage Information

Underwriting Information

Liability

Seating Capacity

Does your establishment have any of the following (check all that apply):

Does your establishment offer any entertainment (check all that apply):

Miscellaneous Information

Hours of Operation

General Information

Current / Previous Insuror

Additional Information