New Franchise or Association Member Program Application

This form is designed to gather enough information to provide an acurate indication of the cost through the Corporate Approved Program. If you have more than four locations, please submit as many forms as necessary. Thank you.

  • Insurance Policy Information

  • MM slash DD slash YYYY
  • Location Information by Store #

  • Store Number:Address 1:Address 2:City:State:Zip: 
  • Building Type by Store #

  • Store Number:What Type of Construction?Sprinklered?Square Footage:Year Built: 
  • Coverage/Rating Information by Store #

  • Store NumberAnnual SalesBuilding Value (if owned)Contents ValueWhere Are You? 
  • Underwriting Information by Store#

  • Store NumberHours of Operation Mon - FriHours of Operation Sat - SunDrive-Thru HoursAlarm System?Central Alarm?Alarm Certificate?Alarm Manufacturer? 
  • Delivery/Catering Exposure

  • Please complete this section if you do any delivery or catering.
  • Automobile Exposure

  • Additional Underwriting Information

  • Liquor Liability Exposure

  • Workers' Compensation

  • Partners/Officers

  • Names of Partners/Corporate OfficersTitle/RelationshipIncluded or Excluded from Workers Compensation 
  • Group Life & Health Coverage

  • If interested, please complete this form and complete our franchise group life and health coverage census
  • Comments

  • * indicates required fields

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