Commercial Property Questionnaire Prefer to fill out by hand? Click here to download a printable version "*" indicates required fields Business Name DBA Federal Tax ID Number Year Established Coverage Effective Date Month Day Year Business Entity Individual Corporation LLC Partnership Other Mailing/Billing Address City State ZIP Code ParishSelect...Acadia ParishAllen ParishAscension ParishAssumption ParishAvoyelles ParishBeauregard ParishBienville ParishBossier ParishCaddo ParishCalcasieu ParishCaldwell ParishCameron ParishCatahoula ParishClaiborne ParishConcordia ParishDeSoto ParishEast Baton Rouge ParishEast Carroll ParishEast Feliciana ParishEvangeline ParishFranklin ParishGrant ParishIberia ParishIberville ParishJackson ParishJefferson ParishJefferson Davis ParishLafayette ParishLafourche ParishLaSalle ParishLincoln ParishLivingston ParishMadison ParishMorehouse ParishNatchitoches ParishOrleans ParishOuachita ParishPlaquemines ParishPointe Coupee ParishRapides ParishRed River ParishRichland ParishSabine ParishSt. Bernard ParishSt. Charles ParishSt. Helena ParishSt. James ParishSt. John the Baptist ParishSt. Landry ParishSt. Martin ParishSt. Mary ParishSt. Tammany ParishTangipahoa ParishTensas ParishTerrebonne ParishUnion ParishVermillion ParishVernon ParishWashington ParishWebster ParishWest Baton Rouge ParishWest Carroll ParishWest Feliciana ParishWinn ParishContact Name First Last Email PhonePrivacy Policy* By submitting my phone number, I hereby authorize Lighthouse Insurance Agency LLC to communicate with me through text messaging. 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Location Address City State ZIP Code ParishSelect...Acadia ParishAllen ParishAscension ParishAssumption ParishAvoyelles ParishBeauregard ParishBienville ParishBossier ParishCaddo ParishCalcasieu ParishCaldwell ParishCameron ParishCatahoula ParishClaiborne ParishConcordia ParishDeSoto ParishEast Baton Rouge ParishEast Carroll ParishEast Feliciana ParishEvangeline ParishFranklin ParishGrant ParishIberia ParishIberville ParishJackson ParishJefferson ParishJefferson Davis ParishLafayette ParishLafourche ParishLaSalle ParishLincoln ParishLivingston ParishMadison ParishMorehouse ParishNatchitoches ParishOrleans ParishOuachita ParishPlaquemines ParishPointe Coupee ParishRapides ParishRed River ParishRichland ParishSabine ParishSt. Bernard ParishSt. Charles ParishSt. Helena ParishSt. James ParishSt. John the Baptist ParishSt. Landry ParishSt. Martin ParishSt. Mary ParishSt. Tammany ParishTangipahoa ParishTensas ParishTerrebonne ParishUnion ParishVermillion ParishVernon ParishWashington ParishWebster ParishWest Baton Rouge ParishWest Carroll ParishWest Feliciana ParishWinn ParishDescription of Business OperationsDo you own the building? Yes No Is the building leased? Yes No Building Value/Replacement Cost Limit in Dollars Landlord Name First Middle Last Landlord Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Owner Occupied? Yes No List TenantsTenant TypeSquare Ft OccupiedRent for Each Add RemoveBusiness Property Contents ValueBusiness Income Limit/Loss of RentsRoof shape and material Square Footage OccupiedSquare Footage of Entire BuildingYear Building Was Constructed Number of Stories in BuildingWhat percentage of the building is sprinklered?Estimated Gross Annual RevenuesProperty Policy Deductibles:Wind/Hail Named Storm All Other Peril Construction of Building Joisted Masonry Frame Masonry Non-Combustible Steel Frame Non-Combustible Does the building have a monitored fire alarm? Yes No Does the building have a monitored alarm system? Yes No Any updates to property? Yes No Update year for wiring Update year for plumbing Update year for roof Update year for heating Pay in full or payment plan? Pay in full Payment plan Additional Interest Type* Builder Mortgage Loss Payee None Other Interest Name PhoneInterest Address City State ZIP Code ParishSelect...Acadia ParishAllen ParishAscension ParishAssumption ParishAvoyelles ParishBeauregard ParishBienville ParishBossier ParishCaddo ParishCalcasieu ParishCaldwell ParishCameron ParishCatahoula ParishClaiborne ParishConcordia ParishDeSoto ParishEast Baton Rouge ParishEast Carroll ParishEast Feliciana ParishEvangeline ParishFranklin ParishGrant ParishIberia ParishIberville ParishJackson ParishJefferson ParishJefferson Davis ParishLafayette ParishLafourche ParishLaSalle ParishLincoln ParishLivingston ParishMadison ParishMorehouse ParishNatchitoches ParishOrleans ParishOuachita ParishPlaquemines ParishPointe Coupee ParishRapides ParishRed River ParishRichland ParishSabine ParishSt. Bernard ParishSt. Charles ParishSt. Helena ParishSt. James ParishSt. John the Baptist ParishSt. Landry ParishSt. Martin ParishSt. Mary ParishSt. Tammany ParishTangipahoa ParishTensas ParishTerrebonne ParishUnion ParishVermillion ParishVernon ParishWashington ParishWebster ParishWest Baton Rouge ParishWest Carroll ParishWest Feliciana ParishWinn ParishCommentsThis field is for validation purposes and should be left unchanged. 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