Commercial Business Survey 1. Have there been any significant changes in the following (auditable) areas? Sales? * Yes No Payroll? * Yes No Other? * Yes No If 'Yes' to 'Other' please specify: 2. Have you acquired, leased, or rented any of the following? Real Estate? * Yes No Vehicles? * Yes No Watercraft? * Yes No Mobile Equipment? * Yes No Other Equipment? * Yes No if 'Yes' to 'Other Equipment', please specify: 3. Have you entered into any written or informal agreement with contractors, suppliers, customers, unions, or others? * Yes No 4. Have you made any changes in corporate structure or partnerships or had new acquisitions? * Yes No 5. Do you perform work and/or have locations outside the state of Indiana? * Yes No If 'Yes' enter States: Building(s) $ * Contents / Inventory $ * Business Personal Property $ * Lease Hold Improvements $ * Specialty Equipment $ * 7. Have your operations changes from those listed in your policy? * Yes No 8. Have you had any service problems with our agency or the insurance company? * Yes No 9. Are there any issues you would like to discuss with us? * Yes No Name: * Business Name: * Phone #: * Email Address: * Date: * Please enter the numbers or letters in the image below If you are human, leave this field blank.
