14887 Hwy 105 W, Suite 102
Montgomery, TX 77356

1-866-TEXAS-45
(1-866-839-2745)

Our Texas Insurance Policies & Coverages

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Texas Liquor Liability Online Insurance Quotes

Please provide the following information:

General Information

Name of Business:
Contact Name:
Mailing Address:
City: State: Zip:
Business Phone: Fax:
Best Time To Call: AM PM
Contact Email Address:
About Your Business
Location Address (if different):
City: State: Zip:
How Long at This Location: years Years in Business: years
Name On License:
Effective Date Requested: Expiration Date:

Type of Operation
Select All That Apply
  1. Tavern or bar without entertainment and annual alcohol beverage receipts over $250,000.
  2. Tavern or bar with entertainment nightclub.
  3. Tavern or bar without entertainment and annual alcohol receipts under $250,000.
  4. Restaurant (over 50% food), hotel, motel, or private club that serves food.
  5. Private Club (no food).
  6. Package liquor store, convenience store or gas station.
  7. Manufacturer, wholesaler, or distributor.
  8. Special event (include supplemental application).
  9. Other (describe in detail below).

Miscellaneous Information
Do you dispense or provide alcoholic beverages for any events off-premises?:
yesno If yes, describe:
Name of person who keeps the books:
Phone:
Sales Information
Past 12 months
Next 12 months
Estimated Sales:
$
$
Gross Sales Other:
$
$
Gross Alcohol Sales:
$
$

Coverage Information

Primary Limits Desired: $ Each Common Cause: $
Aggregate: $ Prior Policy Limits: $
Previous Coverage Information
Previous Liquor Liability Carrier:
Premium: $ Limits: $
Policy Number: Effective Dates:

Underwriting Information

LIABILITY
Seating Capacity:
Dining Room:
Bar:
Outside Deck/Patio:
Other:
Does your establishment have any of the following (check all that apply):
Pinball Machines How Many: Days Per Week:
Video Games How Many: Days Per Week:
Pool Tables How Many: Days Per Week:
Juke box
Dock/Deck Area
Other:
Does your establishment offer any entertainment (check all that apply):
Rock & Roll Nights Per Week:
Disco Nights Per Week:
Band Nights Per Week:
Country Western Nights Per Week:
Piano Nights Per Week:
Juke Box Nights Per Week:
Topless Girls Nights Per Week:
Dancing Nights Per Week:
Happy Hour Nights Per Week:
Other:

Miscellaneous Information

Hours of Operation
Sunday to Closed Closed Part of Day
Monday to Closed Closed Part of Day
Tuesday to Closed Closed Part of Day
Wednesday to Closed Closed Part of Day
Thursday to Closed Closed Part of Day
Friday to Closed Closed Part of Day
Saturday to Closed Closed Part of Day

Employee Information
Number of employees (per shift):
1st Shift 2nd Shift 3rd Shift
Number of bouncers / security:
Bouncers Security

Current / Previous Insuror
Current/Previous Insurance Company:
Policy Number: Expires:
Premium for package policy: $ Limits: $
Is general liability coverage carried: yes no
Applicant ever had insurance cancelled or non-renewed: yes no
If yes, provide details below:
Applicant of any other owner, partner or licensee ever had a liquor license revoked or suspended: yes no If yes, provide details below:

Additional Comments

Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough space, please enter them here.

Please click on the "Submit Quote" button to send your quote request. One of our representatives will respond to your submission as soon as possible.