Bike Shop Form | Bicycle Broker Insurance

Insured Information

Store/Business Name *

First Name *

Last Name *

Job Title

Phone *

Email Address *

Business Address *

Apartment, suite, etc

City *

Province *

Postal Code *

Coverage Date *

Upload current policy documents for a review and comparison

Optional

Store Information

Form of Business *

Business Operations Description *

Year Founded *

Expiry Date of Existing Policy *

Month

Day

Year

Annual Gross Revenue *

Please Breakdown % of Annual Revenue Per Operation *Please specify the percentage of revenue attributed to each of the following categories: Sales, Service, Rentals, E-bike Sales, Snow Sports Goods Sales, Group Rides, Guided Rides, and Other. Ensure that the total percentage equals 100%.

Do you sell E-bikes? *YesNo

Are the E-bike batteries and chargers sold UL Certified? *

What precautions are you taking to avoid E-bike fires such as fire resistive battery bags? *

Do you sell winter gear? *YesNo

Do you sell water sport gear? *YesNo

Company Website

COPE Information

Do you rent or own your building? *YesNo

Building Age

Square Footage

Building Construction

Does the building have a monitored alarm system?YesNo

Does the building have a sprinkler system?YesNo

Year of most recent electrical updates

Age of Roof

Type of Roof

Age of Heating System

Type of Heating System

Age of Plumbing

Type of Plumbing

Consent

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Bike Shops Form

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