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| October 2007, Volume 10 |
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Category: Eating and Drinking Places Risk: Lunchrooms GENERAL CLIENT INFORMATION Account: ___________________________________________________________ Account Number: ____________________________________________________ Agency: ____________________________________________________________ Agency Number: _____________________________________________________ Producer: __________________________________________________________ Producer Number: ___________________________________________________ BUSINESS LEGAL NAME MAILING ADDRESS _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Legal Entity:
SIC CODE(s) ___________________________________ FEDERAL ID NUMBER ____________________________ YEARS IN BUSINESS ___________________________ Number of years under present management: ___ years Number of years experience of owner: ___ years Number of years experience of manager: ___ years Has the risk ever been involved in a bankruptcy procedure? ___ Yes ___ No If yes, explain: _____________________________________________________ Names of subsidiary companies or joint ventures that are not part of this application:___________________________________________________ __________________________________________________________________
The applicant’s primary operations are:______________________________________ _____________________________________________________________________ _____________________________________________________________________ The applicant’s secondary and incidental operations are:________________________ _____________________________________________________________________ _____________________________________________________________________ The applicant used to be involved in the following operations but they have been discontinued: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ The hours of operation are: _____________________________________________ Number of days the business is open per week: _______________ Is this a seasonal operation? ___ Yes ___ No What is the season? From _____________ To _____________ Does the applicant have a safety program? ___Yes ___No Name of safety director: ____________________________________________ Phone number of safety director:_________________________________ Attach copy of safety program. Does the applicant have a disaster plan?_______ Name of disaster coordinator:_________________________________ Phone number of disaster coordinator:________________________ Attach a copy of the disaster plan. Clientele Age: ___ 18-25 ___ 25-35 ___ 35-50 ___ Over 50 Years Clientele Origin: ___ Families ___ Business/Professional ___ Students ___ Military ___ Other ________ Remarks: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Does the establishment specialize in certain foods or drinks? ___ Yes ___ No If yes, explain: ________________________________________________ Does the establishment draw its customers primarily from the immediate area? ___ Yes ___ No If yes, explain: ________________________________________________ Is the establishment located in a shopping center? ___ Yes ___ No What are the gross sales for past 3 years? _________________ 20 ____ Food $ _______________ Liquor $ _______________ 20 ____ Food $ _______________ Liquor $ _______________ 20 ____ Food $ _______________ Liquor $ _______________ Are there operations away from the premises such as catering? ___ Yes ___ No If yes, explain: ________________________________________________ |