Small Business Product Liability Insurance Application
Business Details
Business Name
Contact Person
Email Address
Phone Number
Business Address
Year Established
Number of Employees
Products & Coverage
List of Products
Intended Product Use
Annual Sales (USD)
Coverage Amount Requested (USD)
Product Manufacturing
Are products manufactured by your business?
Yes
No
Are products imported?
Yes
No
Describe Product Safety Measures
Claims & History
Have you held product liability insurance before?
Yes
No
Details of Any Previous Claims (if any)