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Your Name/Restaurant Name:
Contact Phone Number:
Your E-Mail Address:
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Street Address:
City:
State: (must be MN or WI)
Zipcode:
Restaurant Type:
Current Insurance Company:
Renewal Date:
Current Cost:
Any Claims in the Last 3 Years?
Liquor Liability Included in Current Coverage?
Building Coverage:
Age of Building:
Business Property Amount:
Ansul Type:
Deductible:
Catering?
Patio?
Live Music?
DJ?
Total Square Footage:
Public Access Sq. Ft.:
Approximate Gross Sales:
Food Sale %:
Alcohol Sale %:
Number of Employees:

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Stepan Insurance Agency
407 Vermillion Street
Hastings, Minnesota, MN 55033
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Phone: 651-480-1000
Fax: 651-480-0087
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Our Agents are Licensed in Minnesota, Wisconsin, Arizona,
Idaho and Utah