Untitled Document

CGA Associates Salon Quote
We would like to provide you with a free, no-obligation insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Submitting Information

Business Name:
Contact Name:
Street Address:
City:	State: ZIP:
County:	Email:
Business Phone:	Fax:

Applicant Information Section

Name of Business:
Type of Corporation:
Contact Name:
Title:
Mailing Address:
Mailing City:	State: ZIP:
Email:
Phone:
Fax:

Underwriting Information Section
How many chairs do you have ?
How many hair dryer chairs do you have ?
Please supply the name of Each Stylist:

More Underwriting Questions: Hair / Beauty Salon
Does your Salon Offer or Provide Services for...
Electrolysis Services?	yes no
Hair Removal by Electronic Tweezer Services?	yes no
Chiropody or Podiatry Services?	yes no
Wart or Mole Removal Services?	yes no
Reducing, Slendering or Exercising Services?	yes no
Tanning Services?	yes no
Skin Treatments or Facial Services?	yes no
Electric or Steam Baths or Sauna Services?	yes no
Hair Implants or Transplant Services?	yes no
Hair Weaving Services?	yes no
Ear Piercing Services?	yes no
Body waxing Services?	yes no
Body wrapping Services?	yes no
Nail Sculpturing Services?	yes no
Tattoo Services?	yes no
Permanent Make-up Services?	yes no
Hair Straightening Services?	yes no
If Yes, Chemical Base of the Relaxer:
Is There Any Manufacturing, Mixing, Re-Labeling or Repackaging of Any Products?	yes no
If Yes, Please describe:

Loss Information
Losses-Claims in the last 5 years:
If yes, date, amount paid and description of each loss-claim
Current Insurance Company:
Expiration Date:
Current Premium:	$
Comments

Additional Comments:

Please give any additional comments about the coverage you desire: