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Mid Atlantic Insurance Group
The Agency for Agents
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1912 E. Broad Street Richmond, VA 23223
888-300-4720
About Us
Our Carriers
Become an Agent
Submit New Business
Supplemental Forms
Appulate Training
Register: Webinar Training
Feedback
Convenience Store Supplement
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Insured Name:
*
Mailing Address:
*
Location Address:
Phone Number:
*
Hours of Operation:
*
Website Address (Optional):
1. What are the annual receipts from the sale of convenience store items?
*
2. Does the prospect have a canopy that is included in the Building Limit?
Yes
No
If yes, what is the value of the canopy?
3. Are there gas pumps?
*
Yes
No
If yes, # of gas pumps:
Submit
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