[Amazon Seller Insurance] – Breathe Insurance

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 Address*
City
State*
Zip Code*
Year Business Started*What year did you start your busienss?
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.
Annual Gross Sales*What are your business's estimated gross sales/revenues during the next 12 months?
% of sales from imported products*
Number of Employees*Including yourself, how many full-time, part-time, and temporary employees does your business have? (Do not include subcontractors)
Annual Employee Payroll Amount*What do you pay your employees yearly(DO NOT INCLUDE YOURSELF)?
Operations Information

Company Description*
Do you sell any of the following products?
Select All That Apply
- E-cigarettes?
- Vapors?
- Marijuana?
- Knives?
- Guns?
- Supplements or Over the counter Drugs?
- None of the Above
What type of Products Do You Sell?*
Which Item(s) do you sell the most of?
Do you sell Private Label Products?*
- Yes
- No
Private Label Product Name
Private Label URL
Paste a link to your private label product.
What Platforms do you sell on:*
- Amazon
- Ebay
- NewEgg
- Shopify
- Jet
- Other
Do you have any international sales?*
- Yes
- No
What Countries?
Losses*
Have you had any paid business liability insurance losses over the past 5 years?
- Yes
- No
Claims*
Are you aware of any circumstance, allegation, contention or incident which may result in a claim being made against you or your company?
- Yes
- No
Warehousing

Do you have a warehouse or use a 3PL?*
- Yes
- No
What is the value of product you have at your location?*
What is the value of product you have in a Wherehouse?*
Warehouse 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 have a link to your Amazon Store?*
- Yes
- No
Your Amazon Store URL*
Do you store products at a location other than an Amazon Warehouse?*
- Yes
- No
Do you use your personal care to run business errands?*
(Pick up product, move product from home to wear house, move product from store to home etc)
- Yes
- No
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