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Business Insurance Review


By reviewing the below checklist and submitting it to Rosenkilde and Associates, I understand and acknowledge that each area has been reviewed and explained to me. I further understand that if any of my exposures or any coverage preference changes, it is my responsibility to notify Rosenkilde & Associates. A record of this completed review will be kept on file at Rosenkilde & Associates. 
By submitting this form, I declare that this review completed to my satisfaction.   



Link to Disaster Plan information
Optional
Disaster Plan Template
First Name
Required
Last Name
Required
E-Mail Address
Required
Are you authorized to make changes on the business insurance policies?
Required

Business Name
Required
Mailing Address
Required
City and State
Required
ZIP / Postal Code
Required
Has the name or entity type changed?
Optional

If No, do you have a lease in place?
Optional

Notes about above
Optional
Do you haul goods owned by others?
Optional

Are all vehicles titled to the business?
Optional

Do you have a personal auto policy?
Optional


Do you administer a 401k or Retirement Program?
Optional


Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.


ROSENKILDE & ASSOCIATES, RIPPLE & ASSOCIATES, SCALLA INSURANCE
Members of the ABCO/ICS Insurance Services, Inc. Group
All rights reserved 2013