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Business Insurance Application

Peace of mind starts here

Here’s the info we need:

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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?*

1-5

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: 300 MB.

How many employees do you have?*

1-5

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: 300 MB.

How many vehicles are owned in the business name?*

1-5

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: 300 MB.

What is your projected annual revenue for the next year?*

What is your FEIN?

Does your business have a board of directors?

Yes

Does your business have any tools or equipment?*

Yes

What total value would you put on your tools & equipment?*

Are any tools valued at more than $2500?*

Yes

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: 300 MB.

Please attach any supporting documents

Max. file size: 300 MB.

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1605 S Walnut Street
Bloomington, IN 47401

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At Shine Insurance, we are committed to building lasting relationships with our clients. Our goal is to offer clear, practical advice and insurance solutions that help secure your future, all while making the experience as simple as possible.

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