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Please tell us about all major changes that have occurred in the last year so we can update your insurance renewal and make sure you are protected!

Platt – Commercial Renewal Form

"*" indicates required fields

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Full Name:*

First Last

Business Legal Name (and DBA, if applicable):*

Phone Number:*

Email Address:*

Please check all situations that apply to you/your business.*

Business Address Change

New Business Partner

Expanded/Decreased Business Operations

Updates to Commercial Property (new roof, building updates, etc.)

None of the Above Applies

New Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

New Business Partners Name

First Last

Business Partners Date of Birth

MM slash DD slash YYYY

Description of expansion or decrease in business operations.

Description of updates made to commercial building.

Has your insurance carrier recently made requests in regards to a Premium Audit and/or has a Premium Audit recently been completed?*

A carrier can request a premium audit at any point in time and can base it on any or all of the following: Annual Sales, Square Footage, and/or Payroll

Yes

I’m not sure

Have you recently purchased any of the following items that will need to be added to your current policies?*

Vehicles/Toys

Drivers

Commercial Buildings

Equipment/Special Tools

No additions were made

Do you currently use subcontractors or have 1099 employee's?*

Yes

If yes, what percentage of your revenue is generated by the subcontractors?

Do you require them to provide you with proof of insurance?

Yes

Are you currently accepting credit card payments and/or storing customers personal information?*

Yes

How many W-2 employees does your team currently have?*

What is your projected total W-2 payroll for the upcoming 12 months?*

What is your projected gross revenue for the upcoming 12 months?*

You may upload up to 3 files to us, if necessary.

Drop files here or

Max. file size: 98 MB, Max. files: 3.

Would You Like Us To Review Your Policies?

1Start

2Contact Info

3Home Quote

4Auto Quote

5Toys Quote

6Life Quote

7Other Quote

8Referral

Hello! What would you like a quote for?*
- Auto
- Home / Condo
- Tenant
- Business
- Umbrella
- Rental Property
- Motorcycle
- Boat
- Life
- Medicare
- Farm Insurace
Check all that apply. You can tell us if there is something else you need a quote for in just a moment.

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Primary Policyholder Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Date of Birth
MM slash DD slash YYYY

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Is the property address the same as your mailing address?*
- Yes
- No
Property Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How long have you lived at this address?*
- More than or equal to 5 years
- Less than 5 years
Prior Property Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is this a new home purchase?*
- Yes
- No
Closing Date*
MM slash DD slash YYYY
Name of Lender or Bank*
Name of Spouse or other Deed Holder
First Last
Is your basement finished?*
- Yes
- No
In what year was your roof last replaced?*
Do you have any dogs?*
- Yes
- No
What Breed(s)?
Current Insurance Provider*
Current Insurance Premium
Have you had any insurance claims in the last 5 years?*
- Yes
- No
Are you interested in bundling your home and auto to save on your policies?*
- Yes
- No

Save & Continue

How many Drivers are in your Household?*
Driver 1's Name*
First Last
Driver 1's Date of Birth*
MM slash DD slash YYYY
Driver 2's Name*
First Last
Driver 2's Date of Birth*
MM slash DD slash YYYY
Driver 3's Name*
First Last
Driver 3's Date of Birth*
MM slash DD slash YYYY
Driver 4's Name*
First Last
Driver 4's Date of Birth*
MM slash DD slash YYYY
How many vehicles are in your household?*
Vehicle 1 Year*
Vehicle 1 Make and Model*
Vehicle 2 Year*
Vehicle 2 Make and Model*
Vehicle 3 Year*
Vehicle 3 Make and Model*
Vehicle 4 Year*
Vehicle 4 Make and Model*
Current Insurance Provider*
Current Insurance Premium
Have you had any accidents or violations in the last 5 years?*
- Yes
- No
Are you interested in bundling your home and auto to save on your policies?*
- Yes
- No

Save & Continue

Motorcycle Year*
Motorcycle Make*
Motorcycle Model*
Boat Year*
Boat Make*
Boat Model*
Does your boat have a motor?*
- Yes
- No
Do you have a trailer?*
- Yes
- No
Is the garaging address the same as your home address?*
- Yes
- No

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Name of Insured (if different than name listed previously)
First Last
Date*
MM slash DD slash YYYY
Gender*
- Male
- Female
- I'd prefer not to say
Height*
Weight (lbs)*
Do you use Tobacco Products?*
- Yes
- No
Do you use Marijuana or other CBD Products?*
- Yes
- No
Do you have or have a family history of the following:*
- Heart Disease
- Cancer
- Diabetes
- Mental Disorders (including Depression and/or Anxiety)
Select all that apply
What type of Life Insurance Coverage are you looking for?*
- Whole Life
- Term Life
- Universal Life
- Unsure
Select all that apply
Death Benefit Value*
If you are unsure, click here to view our life insurance need calculator: https://www.plattinsurance.com/how-much-life-insurance-do-i-need/

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Thank you for requesting a quote! A licensed agent will be reaching out by the next business day to gather more information.
List any additional information you would like to provide

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What led you to request this quote?*
- Internet Search
- Social Media
- Referral
- Platt Sign
- Community Event
- Other
Who referred you to us?*

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Policy Renewal Updates- Commercial

Please tell us about all major changes that have occurred in the last year so we can update your insurance renewal and make sure you are protected!

Platt – Commercial Renewal Form

Would You Like Us To Review Your Policies?