Client intake

Tell us about your operation.

Share the details of your restaurant so we can prepare a more useful coverage conversation.

Independent neighborhood restaurant exterior at dusk

E&A Insurance Group

Let’s get the details right.

847-651-3834
tom@eaigroup.net
316 W Northwest Hwy, Barrington, IL 60010

Fill in what you know and leave the rest blank. Fields marked with * are required.

Business information

Business entity name *

DBA or restaurant name

Year business started

Years under current owner

Type of restaurant *

Website

Contact information

Contact first name

Contact last name

Title or role

Phone *

Email *

Best way to reach you

Location

Street address *

Suite or unit

City *

State *

Postal code *

Do you own or lease the building?

Operations

Annual sales

Annual liquor sales

Annual payroll

Number of employees

Latest closing time

Do you deliver?

Seating capacity

Square footage

Video gaming

Live entertainment

Maintenance

Do you have your exhaust hood serviced twice a year?

Do you have your Ansul system and fire extinguishers serviced twice a year?

Safety

Is the building sprinklered?

Do you have a fire alarm? *

Do you have a burglar alarm? *

Do you have security cameras? *

Type of Insurance Needed

General liability

Property

Liquor liability

Workers’ compensation

Auto

Umbrella

Cyber

Hired and non-owned auto

Do you currently have insurance?

When do the policies expire?

Have you had any claims in the last 3 to 5 years?

If you had a recent claim, is it settled?

Amount of the claim

Nature of the claim

Notes or questions

Authorization

I confirm this information is accurate to the best of my knowledge and authorize E&A Insurance Group to use it to obtain insurance quotes on my behalf. Completing this form does not bind coverage.

Your name *

Date *