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⛽ Specialty Quote Form

Gas Station & C-Store Insurance Quote

Complete this questionnaire for your gas station and 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 business / opening date Current policy expiration date Business acquisition / closing date Mid-term switch Other Current Policy Expiration Date (if renewing or switching) Do You Own or Lease This Gas Station Property? *
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Business Identity

Legal name, DBA, EIN, and entity type

Entity / Legal Name * DBA / Store Name (if different) EIN # * Legal Entity Type * Select... Sole Proprietorship Partnership LLC S-Corporation C-Corporation Other Years of Experience in Gas Station Business * Month & Year Business Started at This Location * 📍 Property & Mailing Addresses Property Address Street Address * City * State * Select... WashingtonOregonIdaho NevadaArkansasSouth Dakota PennsylvaniaTexasIndiana Other ZIP Code * County * Inside or Outside City Limits? *
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Property & Mailing Addresses

Property Address
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 * 🏗️ Convenience Store BuildingConstruction, size, and renovation history Year C-Store Building Was Built * Building Construction Type *
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Owner / Contact Information

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Convenience Store Building

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 + canopy area) * 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 Alarm System Type *
Renovation History — Most Recent Year for Each System
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Employees & Operations

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Safety & Security Systems

Cameras — Inside Cameras — Outside Do You Have and Use a Safe on Premises?
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Property Values

C-store building, inventory, pumps, canopy, and carwash

Note: Pumps and canopy are valued separately from the convenience store building. Please provide estimates for each category independently.
Estimated Value of C-Store Building (exclude pumps and canopy) * Estimated Value of Inventory Inside Store (beer, tobacco, candy, groceries, everything you sell) * Estimated Value of Pumps & Canopy * Number of Fuel Dispensers * Food Spoilage Coverage Needed?
How Much Coverage? 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 Other Buildings Do You Own Any Other Buildings Adjacent to the C-Store?
Other Buildings
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Annual Sales Breakdown

Underwriters need each category separately

Why each category? Alcohol, tobacco, and fuel sales each carry distinct underwriting and liability exposures. The more accurate these figures, the better we can match you to the right carriers.
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 gas, 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 Annual Gallons of Fuel Sold (gas and diesel combined) * Select range... Under 500,000 gallons 500,000 – 1,000,000 gallons 1,000,000 – 2,000,000 gallons 2,000,000 – 4,000,000 gallons Over 4,000,000 gallons Do You Sell Fresh Vegetables, Fruits, or Uncooked Meat? *
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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 Fill Propane at This Location? *
Can Customers Exchange Propane Tanks? *
Any Other Business at This Location? (other than gas station and C-store)
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Current Insurance & Claims History

Current Insurance Company Current Policy Number Any Claims in the Last 5 Years? *
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Upload Documents (Optional but Recommended)

Attach current dec pages and/or loss runs

Tip: Attaching your latest policy and loss runs helps us find the best carrier match faster — especially important for gas stations, which have a more specialized underwriting market.
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 gas station and C-store insurance options tailored to your operation.

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