Restaurant Questionnaire

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Legal Entity Name*

Doing Business As (if applicable)

Type of Restaurant (Bar, Nightclub, Fine Dining, Etc.):*

Business Physical Address*

Street Address Address Line 2 City State ZIP Code

*If your state is not shown, then JMG may not have a market for this state.

Mailing Address

Same as previous

Square Feet of Location

Any Claims In The Last Five Years*

Full-Time Employee Count

Part-Time Employee Count

Estimated Annual Payroll

Estimated Annual Food Sales

Estimated Annual Liquor Sales

Value of Contents:

Forms of Entertainment (Live Music, Games, DJ’s, Etc.)*

Federal Tax ID Number

Any Additional Info

Auto Quote Needed?

Contact Person Name*

Phone Number*

Email Address*

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Agent

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