Skip to the content
Intermarket Insurance Agency
Insurance
Auto, Home & Personal Insurance
Auto Insurance
Boat & Marine Insurance
Condominium Insurance
Flood Insurance
High Net Worth Coverage
Homeowners Insurance
Motorcycle Insurance
Renters Insurance
Improv Defensive Driving Course NY
- View All Personal
Business Insurance
Business Owners Package Insurance
Commercial Auto Insurance
Commercial Property Insurance
Commercial Umbrella Insurance
General Liability Insurance
Hotel & Motel Hospitality Insurance
Professional Liability (E&O) Insurance
Restaurant & Tavern Insurance
Surety Bonds
Workers’ Compensation Insurance
- View All Business
Specialty Programs
Landscape Architects
Board Retailers and Surf Schools
In-Home Companion Care
Cyber Liability Insurance
Restaurant & Tavern Insurance
Online Retailers Policy Info
Restaurant & Tavern Policy Info
Intellectual Property Policy Info
UAV Insurance Application
RE360
Real Estate Liability and Property Quote
EXIT Realty Insurance Program
EDU-PRO
Mathnasium
Sylvan Learning Center
ClubZ!
LearningRx
Stemtree
Grade Power
About
Meet Our Staff
Our Insurance Carriers
Customer Reviews
Our Agency Partners
Insurance Blog
Policy Service
File a Claim
Online Billing & Payments
Certificate of Insurance Request
Policy Change Request
Auto ID Card Request
Insurance Resources
Contact
Huntington Office
Secure Contact Form
Refer A Friend
Home
>
EDU-PRO New and Additional Location Questionnaire Form
EDU-PRO New and Additional Location Questionnaire Form
General Information:
Corporate Name & DBA:
Deleting a Location:
Are you deleting a location?
Yes
No
If Yes, please provide the following information:
Street:
City:
State:
Zip:
Date Deleted:
Address of New Location:
Street:
City:
State:
Zip:
Landlord’s Information:
Name:
Street:
City:
State:
Zip:
Please Answer Each Question:
Date to add new location:
Do you own the building this Center is in?
Yes
No
Year building was built?
Square Footage:
Number of Stories:
Linear feet of exterior glass:
Construction of building?
Frame
Masonry
Fire Resistive
Non-Combustible
Does your Center have a Central Station Fire/Burglar Alarm?
Yes
No
Does your Center have a Sprinkler System?
Yes
No
Business Property Limit: $
Tenants Improvements & Betterments: $
Do you wish to increase the payroll on your Workers Comp Policy?
Yes
No
If yes, enter New total payroll amount: $
Estimated Annual Gross Receipts
Phone
This field is for validation purposes and should be left unchanged.
Δ