BigApple Insurance Brokerage – We make a difference in the moments that matter

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BIG APPLE INSURANCE INC.

143-15 HILLSIDE AVE JAMAICA, NY 11435
Phone: 718-739-7500
Fax: 718-206-2667
Email: lucky@bigappleinsurance.nyc

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NEW CLIENT FORM

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INSURANCE NEEDED:

1. GENERAL LIABILTY
2. WORKERS COMP
3. DIABILITY
UMBRELLA
HIRED/NON-OWNED AUTO

ARE YOU WORKING WITH:

1. DOT - DEPT OF TRANSPORTATION
2. DOB - DEPT OF BUILDINGS
3. NYCHA
. HPD - HOUSING

PLEASE SEND A COPY OF YOUR DRIVER'S LICENSE,
IRS SS4 FORM, FILING RECEIPT, CERTIFICATE OF INCORPORATION

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