[Amazon Seller Insurance Ashlin]

Business Name*Business Name
This is the name that will appear on your policy documents. If you do not have a business name, please list your name.
Business Entity Type:*
- Individual
- Partnership
- LLC
- Corp
- Other
Do you have a DBA?
Please list any other names you sell under on any other platforms
Business Street Address*
Business Address City
Business Address State*
Business Address Zip Code*
Do you have a different Mailing Address?
- Yes
- No
Mailing Street Address*
Mailing Address City
Mailing Address State*
Mailing Address Zip Code*
Year Business Started*What year did you start your business?
Are you operating your business out of your home?
- Yes
- No
Area Occupied
If you are a building owner, the area provided should represent the total square footage of the building. If you are a tenant, the area provided should represent the area associated only with their operation.
Nest Year Anticipated Annual Sales*What are your business's estimated gross sales/revenues during the next 12 months?
% of sales from imported products
Please enter a number less than or equal to 100.
Operations Information

Company Description*
Do you have 50% or more Common Ownership in any other Business Entity?
- Yes
- No
Do you sell any of the following products?*
Select All That Apply
- Tobacco Products including E-Cigarettes, Vapors or Marijuana
- Knives
- Firearms or Ammunition
- Vintage items – Antiques or Restored Items
- Dietary Supplements over 25% of your Total Sales
- Adult Novelty Items
- Baby Products, Car Seats, Cribs or Furniture
- Medical Grade Accessories & Products (Medical Test Strips, Medical Devices, Handheld Massagers, Etc)
- None of the Above
Do you sell Private Label Products?*
- Yes
- No
Do you put your Band Name on any Products?
Private Label Product Name
Private Label URL
Paste a link to your private label product.
Do you do any of the following?*
- Re-label
- Re-package
- Design or have products designed on your behalf
- Assemble
- Manufacture or have products manufactured on your behalf
- None of the above
Are you Directly Importing Products to yourself from China or Mexico? *
- Yes
- No
Describe Type of Products You Sell?*
Which Item(s) do you sell the most of?
What Platforms do you sell on:*
- Amazon
- Ebay
- NewEgg
- Shopify
- Jet
- Other
List other Platforms
Do you have any international sales?*
- Yes
- No
Which Countries?
Any claims or losses or known circumstances that could cause a claim in the past 3 years?*
- Yes
- No
Describe Losses and/or Claims
Warehousing

Do you have a Warehouse or use a 3PL?*
- Warehouse
- 3PL
- No
What is the Value of Product that you have in Warehouse?*
What is the value of product you have in a 3PL?*
Warehouse Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
3PL Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Does the Warehouse have a sprinkler system?*
- Full Sprinkler
- Partial Sprinkler
- NONE
Amazon Information

Do you use your personal car to do business errands? (pick up product, move product from home to warehouse, more product from store to home, etc)*
(Pick up product, move product from home to wear house, move product from store to home etc)
- Yes
- No
Do you store any Customer Information on your Computer?
- No
- Yes
Do you want coverage for your business personal property (inventory) stored on your primary location?
- Yes
- No
How much Personal Property Coverage would you like?
Do you have Employees?

Do you have W-2 Employees?*
Number of Employees*Including yourself, how many full-time, part-time, and temporary employees does your business have? (Do not include subcontractors)
Total Annual Employee Payroll Amount*What is your total annual payroll amount (DO NOT INCLUDE YOURSELF)?
Would you like a Workers Compensation Quote?*
Employee Classification and Payroll
Warehouse Employees
Class Code
Number of Employees*
Total Annual Payroll*
Clerical / office/ sourcing agents Employees
Class Code
Number of Employees*
Total Annual Payroll*
Outside Sales
Class Code
Number of Employees*
Total Annual Payroll*

Contact Information