Business Insurance Application | Shine Insurance Agency

Insurance
About
- Why Shine
- Team
- FAQs
- How We Give Back
- Podcast
Articles
CLIENT CENTER

Request Proposal

Business Insurance Application

Love that you're interested in teaming with Shine.

Please provide a few bits of info below and we'll reach out with next steps.

Step 1 of 3

33%

First Name*
Last Name*
Business Name*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Phone*
(###)###-####
Email*
Enter Email Confirm Email
How did you hear about Shine?*
Website
What does your business do?*

How many years has this entity been in business?*
- Just starting
- 1-2 Years
- 3-5 Years
- 6 Years +
How many years of management experience do you have in the industry?*
In what state is your business registered?*
How many locations do you have?*
- 0
- 1-5
- 6+
Will you be attaching a document that lists your locations?*
- No, I can list them here
- Yes, I'll attach a document
Please list the address of each location*
Please attach a list of locations*
Max. file size: 50 MB.
How many employees do you have?*
- 0
- 1-5
- 6+
What is your total payroll?*
Will you be attaching a document that lists your employees?*
- No, I can list them here
- Yes, I'll attach a document
Please list the names of your employees*
Please attach a list of employees*
Max. file size: 50 MB.
How many vehicles are owned in the business name?*
- 0
- 1-5
- 6+
Will you be attaching a document that lists your vehicles?*
- No, I can list them here
- Yes, I'll attach a document
Please list the Yr, Make, Model of each vehicle*
Please attach a list of vehicles*
Max. file size: 50 MB.
What is your projected annual revenue for the next year?*
What is your FEIN?

Does your business have a board of directors?
- Yes
- No
Does your business have any tools or equipment?*
- Yes
- No
What total value would you put on your tools & equipment?*
Are any tools valued at more than $2500?*
- Yes
- No
Please list tools valued more than $2500 & their value*
If you have a long list please attach on the next page
Are they any specific concerns or coverages we should address?
Please attach your current policies
Max. file size: 50 MB.
Please attach any supporting documents
Max. file size: 50 MB.
Phone
This field is for validation purposes and should be left unchanged.

25689

Menu

PERSONAL BUNDLES
REAL ESTATE INSURANCE
About Shine Insurance
RESOURCES
Blog
REQUEST PROPOSAL
CLIENT CENTER

REQUEST PROPOSAL

Contact

812.679.8779
101 W Kirkwood Ave
Suite 134
Bloomington, IN 47404

Business hours

Mon-Thurs 9am - 5pm
Friday 9am-12pm

Cleantalk Pixel