Hotel / Motel

Name*

First Last

Email*

Corporate Name

DBA Hotel Name

Fed. Tax ID

Franchise ID Nmber

Hotel Address

Street Address City Kentucky or Tennessee only ZIP Code

We only insure Kentucky and Tennessee

Hotel Fax

Hotel Phone

Number of Roooms

Number of Stories

Pool on Site

Sprinkler System

Monitored Alarm System

Electronic Key Cards

Type of Construction

Type of Roof

Year Built

Building Value

Contents (FF&E) Value

Annual Gross Sales

Agent Name (Optional)

How Did You Hear About Us?

Preferred Contact Method

Additional Comments