Insurance Form Questionnaire

Insurance Form Questionnaire

Insurance Form Questionnaire Form Preview
Insurance Form Questionnaire
  • Ted Silberg
  • Short Form Questionnaire

    For Informational purposes only
  •   Current Year to date Calendar Year 2015 Calendar Year 2014 Calendar Year 2013
    Period (indicate if different than the above headings)
    Insurable Sales
    Total Value of all Sales
    Largest Bad Debt
    Number of Losses
  •   Range Credit Limits # of Customers
    Over $250k
    $100-$250k
    $50k-$100k
    $25k-50k
    $10-$25k
    Under $10k
  •   Total Amount Outstanding
    Current - Not yet due
    1-30 days
    31-60 days
    61-90 days
    Over 90 days
  •   Date Amount
    Quarter Ending
    Quarter Ending
    Quarter Ending
    Quarter Ending
  •   Buyers Buyers
  •   Country Annual Sales No. of Buyers
    1.
    2.
    3.
    4.
    5.
    6.
    7.
  • Should be Empty: