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What is the entity/status?
Partnership
S Corporation
C Corporation
Joint Venture
Limited Liability Corporation
Individual/Sole-Proprietorship
Municipality
Trust
How many years in business?
0-2 Years
3-5 Years
6-10 Years
11-20 Years
20+ Years
What type of property/casualty insurance do you need?
(check all that apply)
Property Insurance
What are the desired employee benefits?
(check all that apply)
Employee Benefits
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What is your gross annual revenue?
(it's OK to estimate)
Less than $50,000
$50,001-$100,000
$100,001-$250,000
$250,001-$500,000
$500,001-$1,000,000
$1,000,001-$5,000,000
$5,000,001-$10,000,000
$10,000,000+
What is your gross annual payroll?
(it's OK to estimate)
Less than $50,000
$50,001-$100,000
$100,001-$250,000
$250,001-$500,000
$500,001-$1,000,000
$1,000,001-$5,000,000
$5,000,001-$10,000,000
$10,000,000+