Restaurant Application - Balcos Insurance, Inc.

 

Please Select Your Business Type

Choose One:	Restaurant with lounge Restaurant without lounge Fast food Fast food with drive-thru Bar / Lounge Brew pub Tavern Winery Caterer Hotel / Motel Nightclub Food delivery Pizza parlor
Other (Describe)

Please Complete All Fields

I wish to Submit my Application Online Print my Application (For Mailing)
DBA Name :*
Address :*
E-mail Address :*
Verify E-mail Address :*
Contact Name :*
Contact Phone :
Best Time To Call:
Interested in becoming a WRA member?	Yes No Already a member

 

How long have you been at this location?
How many locations do you have?
Do you have live entertainment?	Yes No
Do you have dancing?	Yes No
Lounge hours different from dining?	Yes No
Food sales higher than alcohol sales?	Yes No

 

Policy expiration date?
What are your projected sales for the coming year:
Food:
Alcohol:

OR

8746 Mary Ave NW Suite 2 Seattle WA 98117 • 206.783.1986 • 206.783.4408 fax