Business Insurance Application | Shine Insurance Agency

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Business Insurance Application

Love that you're interested in teaming with Shine.

Please provide a few bits of info below and we'll reach out with next steps.

Step 1 of 3

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First Name*
Last Name*
Business Name*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Phone*
(###)###-####
Email*
Enter Email Confirm Email
How did you hear about Shine?*
Website
What does your business do?*

How many years has this entity been in business?*
- Just starting
- 1-2 Years
- 3-5 Years
- 6 Years +
How many years of management experience do you have in the industry?*
In what state is your business registered?*
How many locations do you have?*
- 0
- 1-5
- 6+
Will you be attaching a document that lists your locations?*
- No, I can list them here
- Yes, I'll attach a document
Please list the address of each location*
Please attach a list of locations*
Max. file size: 50 MB.
How many employees do you have?*
- 0
- 1-5
- 6+
What is your total payroll?*
Will you be attaching a document that lists your employees?*
- No, I can list them here
- Yes, I'll attach a document
Please list the names of your employees*
Please attach a list of employees*
Max. file size: 50 MB.
How many vehicles are owned in the business name?*
- 0
- 1-5
- 6+
Will you be attaching a document that lists your vehicles?*
- No, I can list them here
- Yes, I'll attach a document
Please list the Yr, Make, Model of each vehicle*
Please attach a list of vehicles*
Max. file size: 50 MB.
What is your projected annual revenue for the next year?*
What is your FEIN?

Does your business have a board of directors?
- Yes
- No
Does your business have any tools or equipment?*
- Yes
- No
What total value would you put on your tools & equipment?*
Are any tools valued at more than $2500?*
- Yes
- No
Please list tools valued more than $2500 & their value*
If you have a long list please attach on the next page
Are they any specific concerns or coverages we should address?
Please attach your current policies
Max. file size: 50 MB.
Please attach any supporting documents
Max. file size: 50 MB.
Name
This field is for validation purposes and should be left unchanged.

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Contact

(812) 679-8779
PO BOX 5187
Bloomington, IN 47407

Business hours

Mon-Thurs 9am - 5pm
Friday 9am-12pm

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