Online Application - Independent Food and Beverage Insurance Brokers, Inc.

Contact Us:

Toll Free: 800-336-6121

Phone: 201-460-8465

Fax: 201-460-8467

P.O. Box 907

333 Valley Brook Avenue

Lyndhurst, NJ 07071



Thank you for your interest in Independent Food and Beverage Insurance Brokers, Inc. Please submit the information below and someone will contact you shortly. Fields marked with an asterisk (*) are required.

*Business Trade Name:
Liquor License Number:
Address 1:
Address 2:
City:
State:
Zip:
*Contact Name:
*Email Address:
Phone:

Renewal Month:
Current Agent:
Current Company:
Premium:
Type of Operation:	Example: Restaurant/Tavern, Sports Bar, Nite Club

Property Coverage
Building Limit:
Contents Limit:
Building Age:
Construction:	Example: Wood, Brick
Apartments:
Number of Units:
Sprinkler System:
Years at this location:
Liability Limit:
Annual Food Sales:
Annual Liquor Sales:
Entertainment Type:	Example: Bands, Karaoke, Disc Jockey

Workers Compensation
Payroll Restaurant:
Payroll Clerical:

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