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🏪 Specialty Quote Form

Convenience Store Insurance Quote

Complete this questionnaire for your convenience store. A licensed broker will respond with coverage options within one business day.

✓ No obligation
✓ Multiple carriers compared
✓ Response within 1 business day
✓ 18+ years commercial experience
0% complete
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Policy Timing

Coverage start, takeover, or expiration date

Effective / Start Date * Reason for This Date * Select one... New store / opening date Current policy expiration date Store acquisition / closing date Mid-term switch Other Current Policy Expiration Date (if renewing or switching) Do You Own or Lease This C-Store? *
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Store Identity

Legal name, DBA, EIN, and entity type

Corporation / Legal Name * DBA / Store Name (if different) EIN # * Legal Entity Type * Select... Sole Proprietorship Partnership LLC S-Corporation C-Corporation Other Year Business Started at This Location * 📍 Property & Mailing Addresses Property / Store Address Street Address * City * State * Select... WashingtonOregonIdaho NevadaArkansasSouth Dakota PennsylvaniaTexasIndiana Other ZIP Code * County * Mailing Address (if different from above) Mailing Street Address City State ZIP 👤 Owner / Contact Information Owner's Full Name * Owner's Cell Phone * Owner's Email Address * Hours of Operation * 🏗️ Building DetailsConstruction, size, and renovation history Year C-Store Was Built * Building Construction Type *
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Property & Mailing Addresses

Property / Store Address
Mailing Address (if different from above)
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Owner / Contact Information

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Building Details

Construction, size, and renovation history

C-Store Square Footage * Number of Stories * Select... 1 story2 stories 3 stories4+ stories Is There a Basement? *
Total Property Area Sq Ft (store + parking lots) * Renovation History — Most Recent Year for Each System Plumbing Updated Wiring Updated Heating Updated Roof Updated 👷 Employees & Operations Full-Time Employees * Part-Time Employees * Total Annual Payroll * Select range... Under $100,000$100,000 – $250,000 $250,000 – $500,000$500,000 – $1,000,000 $1,000,000 – $2,500,000Over $2,500,000 Cash Kept Overnight * 🔒 Safety & Security Systems Fire Sprinkler System Installed? *
Renovation History — Most Recent Year for Each System
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Employees & Operations

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Safety & Security Systems

Alarm System Type *
Cameras — Inside Cameras — Outside Do You Have and Use a Safe on Premises?
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Property Values & Coverage

Building, inventory, spoilage, and carwash

Estimated Value of C-Store Building * Estimated Value of Inventory Inside Store (beer, candy, cigarettes, grocery — everything you sell) * Food Spoilage Coverage Needed?
How Much Coverage? Total Annual Gross Sales * Select range... Under $250,000$250,000 – $500,000 $500,000 – $1,000,000$1,000,000 – $2,500,000 $2,500,000 – $5,000,000$5,000,000 – $10,000,000 Over $10,000,000 Carwash Does This Location Have a Carwash? *
Carwash
Number of Bays Type of Carwash Select... Automatic / drive-through Self-serve / manual bays Both automatic and self-serve Touchless Value of Carwash Building Value of Carwash Contents & Equipment 📊 Annual Sales BreakdownUnderwriters need each category separately Why each category? Alcohol, tobacco, and fresh food sales each carry distinct liability exposures. The more accurate these figures, the better we can match you to the right carriers and coverage. Annual Alcohol Sales * Select range... None sold Under $50,000$50,000 – $100,000 $100,000 – $250,000$250,000 – $500,000 Over $500,000 Annual Tobacco Sales * Select range... None sold Under $50,000$50,000 – $100,000 $100,000 – $250,000$250,000 – $500,000 Over $500,000 Annual Grocery Sales (exclude tobacco, alcohol, and lottery) * Select range... Under $100,000$100,000 – $250,000 $250,000 – $500,000$500,000 – $1,000,000 $1,000,000 – $2,500,000Over $2,500,000 Do You Sell Fresh Vegetables, Fruits, or Uncooked Meat? *
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Annual Sales Breakdown

Underwriters need each category separately

Why each category? Alcohol, tobacco, and fresh food sales each carry distinct liability exposures. The more accurate these figures, the better we can match you to the right carriers and coverage.
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On-Site Services & Special Operations

Additional services that affect coverage needs

Do You Do Deep Frying / Cooking at This Store? *
Describe Cooking Operations Is There a Fast Food Operation on Premises? *
Fast Food Brand / Tenant Name Is There an Auto Repair Shop at This Location? *
Number of Service Bays Type of Repairs Performed Do You or Can Customers Fill Propane at This Location? *
Annual Propane Fill Sales Can Customers Exchange Propane Tanks? *
Annual Tank Exchange Sales 📋 Current Insurance & Claims History Current Insurance Company Current Policy Number Any Claims in the Last 5 Years? *
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Current Insurance & Claims History

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Upload Documents (Optional)

Attach current dec pages and/or loss runs to speed up quoting

Current Dec Page(s)
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Declarations Page

PDF, JPG, PNG, or DOC — max 10 MB

    Loss Runs
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    Loss Run Report

    3–5 years preferred — PDF, XLS, or DOC

      Max 10 MB per file  ·  You can also email documents directly to CommercialInsuranceAgency@gmail.com

      Ready to Submit?

      A licensed commercial broker will review your submission and respond within one business day with convenience store insurance options tailored to your operation.

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