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On-Line Restaurant
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Name/Restaurant Name:  
Contact Phone Number:  
Your E-Mail Address:  
Confirm E-mail Address Again:  
Street Address:  
City:  
State:  
Zipcode:  
Restaurant Type:  
Current Insurance Company:  
Renewal Date:  
Current Cost:  
Any Claims in the Last 3 Years?  
Liquor Liability Included in Current Coverage?  
Building Coverage:  
Age of Building:  
Business Property Amount:  
Ansul Type:  
Deductible:  
Catering?  
Patio?  
Live Music?  
DJ?  
Total Square Footage:  
Public Access Sq. Ft.:  
Approximate Gross Sales:  
Food Sale %:  
Alcohol Sale %:  
Number of Employees:  

Carmar Insurance Agency . 306 N. State College Blvd. . Anaheim, CA 92806
Phone: 714-535-5510 | Fax: 714-535-5511 | E-Mail us at: myagent@carmar.net
Our Telephone Quoting Hours are: 9:00am - 5:00pm (M-F) | California Lic #0C94230
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