(219) 395-1747
760 S Calumet Chesterton, IN 46304
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South Shore Insurance, Inc
Christine J Newton Agency 760 S Calumet Rd Chesterton, In 46304
Home Quote Sheet
Legal name of business:
DBA name of business:
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Corporation
Sole Proprietor
Partnership
LLC
Federal ID:
Year Business Started:
Location Address:
Mailing Address:
Type of business:
Description of what business does:
Owners Name:
Date of Birth:
Address:
Social:
Number of employee:
Annual estimated payroll:
Annual Cost of Subcontractors:
Annual Gross Sales: (aprox.):
Prior insurance company:
Type of prior policies: (check all that apply)
General Liability
Workers Comp
Property
Commercial Auto
Commercial Umbrella:
Group Health
Business Life
Renewel Date:
Claims in the last 3 years?
Security Check:
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