Tech Manufacturing Insurance Quote | Advantixx Insurance Group

Applicant Information

Business Legal Name*

DBA / Trade Name (if applicable)

FEIN / Tax ID*

Entity Type*

Business Address*

City*

State*

ZIP Code*

Business Phone*

Contact Email*

Contact Person / Owner Name*

Title / Position

Year Business Established*

Years Under Current Ownership*

Website URL

Manufacturing Operations

Primary product type manufactured*

Describe in detail the products you manufacture*

0/500

Annual Gross Revenue ($)*

Annual Payroll ($)*

Full-Time Employees*

Part-Time Employees

Seasonal Employees

Do you design the products you manufacture?*

YesNoBoth

Do you use subcontractors for any manufacturing?*

YesNo

Estimated % of work subcontracted

Do you import components or raw materials from outside the US?*

YesNo

Do you export finished products outside the US?*

YesNo

Are any products sold under your own brand/label?*

YesNo

Do any products require FDA approval or clearance?*

YesNoIn Process

Do any products require UL, CE, or other certifications?*

YesNo

List certifications held (UL, CE, ISO, FDA 510k, etc.)

0/500

Do you perform quality control / testing on finished products?*

YesNo

Do you have a product recall plan?*

YesNo

Estimated value of raw materials / WIP inventory ($)*

Estimated value of finished goods inventory ($)*

Premises & Property

Vehicles & Equipment

Do you own or operate vehicles for business use?*

YesNo

Number of owned vehicles

Number of hired/non-owned vehicles

Do you use forklifts or heavy equipment?*

YesNo

Do you use cranes or overhead lifting equipment?*

YesNo

Claims History (Past 5 Years)

Have you had any losses or claims in the past 5 years?*

YesNo

If yes, describe each claim (date, type, amount, status)

0/500

Have you ever been cancelled or non-renewed by an insurer?*

YesNo

If yes, explain

0/500

Current Insurance

Current insurance carrier

Current policy expiration date

Current annual premium ($)

Desired effective date for new policy*

Coverage Requested — Select All That Apply

Additional Information

Any additional information you would like us to know

0/500

Technology Manufacturing Insurance Quote

Applicant Information

Manufacturing Operations

Premises & Property

Vehicles & Equipment

Claims History (Past 5 Years)

Current Insurance

Coverage Requested — Select All That Apply

Additional Information