Carter & Company, L.L.P.



(If not in Texas, please click here to view a list of states in which we currently have non-resident licenses.  If your state is not listed then we would not currently have a market for you.)

In Home Business

If you would like a representative of Carter and Company to contact you regarding
In Home Business Coverage, please fill in the form below.  If you would like a quote, scroll down to the In Home Business Questionnaire, fill it out in its entirety and submit it to us.  Either way, we will get back to you as soon as possible.

Information Request Form

Select the items that apply, and then let us know how to contact you.

Send product literature
Send company literature
Have a salesperson contact me

Name
Title
Company
Address
E-mail
Phone

      

 

HOME BUSINESS QUESTIONNAIRE
First Name:
Last Name:
Business Name:
Mailing Address:
Property Address:
City:
State:
Zip Code:
County Name
Texas Resident Only
Construction Type
Texas Resident Only		 Frame  Masonry
*Social Security # or *FEIN
*Required by insurance
  companies in order to quote
Phone Number:
Fax Number:
E-Mail Address:

 

UNDERWRITING
Please check which box is applicable to the named insured: Individual Partnership/Joint Venture 
Corporation
Select Your Classification:
Please Fully Describe the Nature of Your Business

Current Insurance Company:
Put None If Applicable
Business License Number:
Put None If Applicable
License Type:
Put N/A If Appropriate
Years of Experience:
If yes, date, amount paid and description of each loss-claim

ADDITIONAL INSURED/LOSS PAYEE INFORMATION
Additional Insured /Loss Payee Additional Insured Loss Payee
Additional Insured Info Controlling Interest in business
 Co-owner of insured premises
 Manager or Lessor of Premises
 Lessor of leased equipment
 Owner or lessor of leased land
 Grant of Franchise
 State/Political Subdivision
       (for permits relating to the premises)
 Dispatcher or referral service
Additional Insured /Loss Payee Name
Additional Insured /Loss Payee Address
City, State, Zip		 ,  
What interest does the additional insured have in the insured's business?  (Response is mandatory for Controlling Interest and Grantor of Franchise.)

GENERAL UNDERWRITING INFORMATION
Is your business office based in an area other than your residence? (residence includes outbuildings within 100 feet) NoYes
Losses or claims of any type, relating to your business operation, in the last three years? NoYes
Single claim, related to your business, for more than $25,000 in the last three years? NoYes
Do you own any business under the same legal name as the "Business Name" shown, which is operated at a different location? NoYes
Do you repackage food or personal care products to be sold under your own label? NoYes
Are you involved in the sale or manufacturing of explosives or propellants? NoYes 
Do you install any products, excluding the installation of computer systems, office equipment, security devices or draperies? NoYes
Is your business operated by someone other than yourself and/or another immediate family member who resides in your household? NoYes
Did your gross annual sales/receipts from your business pursuits for the most recent calendar year exceed $250,000 for sale of merchandise or $500,000 for a service business? NoYes
Total Estimated annual revenues
Estimated Annual Revenues from your manufactured products or imports
Do you employ more than three (10) employees, other than independent contractors or distributors? NoYes
Is your dwelling located within 1,500 feet of salt water in a coastal county on the Gulf of Mexico or the Atlantic Ocean? NoYes
If you are a teacher or tutor, do you provide instruction for sports, physical education, industrial arts, or martial arts? NoYes
Do you perform any vehicle repair services (other than oil changes, oil filter changes or glass repair)? NoYes

INFORMATON ABOUT COVERAGES DESIRED
Business Property Amount $:
(No Building Coverage)
On premises and while temporarily off premises. 
Must equal 100% of replacement cost.
(Minimum Limit $5,000/Maximum limit $50,000)
Business Liability Each Occurrence $300,000
$500,000
$1,000,000
(Medical Payments of $5,000 each person included)  Class limitations and exclusions may apply.

Policy Deductible $250 Standard
(None other available) 

OPTIONAL COVERAGES
Electronic Data Processing Amount $:
Equipment, data & media
(Maximum Limit of $25,000.  The sublimit for off-premises EDP coverage is $5,000.  No other policy limit may be added to the sublimit.)

Money and Securities
(On/Off Premises)

 $1,000/$1,000 $2,000/$1,000
$3,000/$1,000 $4,000/$1,000
$5,000/$2,000 $7,500/$2,000
$10,000/$5,000

 

 

 

                                                                                                                         

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