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Home » Fire Contractor Questionnaire

Fire Contractor Questionnaire

Please complete our fire contractor questionnaire and we will get in touch with you very shortly.

"*" indicates required fields

Business Name*

Address*

Street Address City State ZIP Code

Contact Name*

First Last

Phone

Email*

What year was business established?

Do you have any engineers or architects on staff that design systems?

Yes

No

Are you an "Authorized Dealer" for any specific manufacture(s)?

Yes

No

If yes, please list names:

Are you a member of any trade organizations?

Yes

No

If yes, please list:

Please list the states in which you conduct business.

How many employees do you have?

How many vehicles do you have?

What is your annual payroll breakdown by the type of work you perform below?

Fire Suppression Installation, Service & Repair

Restaurant Suppression Systems

Fire Extinguisher Services

Hood & Duct Cleaning

Fire Alarm Systems

All Other

What type of accounts do you service?

Office & Retail

Industrial & Manufacturing

Restaurants

Apartments & Condos

Hotels & Motels

Hospitals & Nursing Homes

Other

Are you a wholesale distributor of Fire & Safety Equipment?

Yes

No

If yes, what are your Annual Gross Sales?

Do you use subcontractors to do any work?

Yes

No

What is your Federal Id Number? (Needed for Workers Compensation quote)

What is the name of your current Insurance Company?

When does your current Insurance Policy Expire?

Have you had any Liability Claims in the past 5 years?

Yes

No

Please indicate the coverage's that you would like us to quote

General Liability

Property

Tools

Commercial Auto

Workers Compensation

Group Health Insurance

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Rochester Hills, MI 48307

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