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For a list of quote forms available, please press "Applications" tab above.

          R.R.I.S. Beauty Salon/ Barber Shop Questionnaire                 


To request a no-cost, no-obligation insurance quote, just fill out the information below and press the submit button.

You may print and fax to our office if you wish.  We'll have a representative call at your convenience to give you a quote.

Ritchie and Rose Insurance Services, Inc. DOI#0F44143, PO Box 1114, Anderson, CA  96007

email: sherir@ritchieandrose.com

http://www.ritchieandrose.com

Phone: 530-365-4705   Toll Free Fax: 866-885-1428                                       

ATTN:  Ritchie & Rose

 (sherir@ritchieandrose.com)
TOLL FREE FAX:  (866) 885-1428

 

Please provide the following information:    

Referral Agent

(The Referral Agent is the name of your Insurance Agent in our office or how you became aware of our website)

First Name
Last Name
Title
DBA
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
FEIN #
Work Phone
Home Phone
FAX
E-mail
URL
Beauty Salon & Barber Shop Supplemental Application
Date: 
Applicant:  Agent: 
Describe the process and products used to perform the following services:
Hair dying and shampoo tinting: 
Eyebrow & eyelash coloring: 
Stain removing: 
Dry Shampoo: 
Electrolysis: 
Hair removal if other than electrolysis: 
Hair straightening: 
Describe all services or treatments not mentioned above:
List any products that you re-package, re-bottle or re-label in your name:
Are pre-disposition tests run before applying products?  Yes    No
Are permanent records kept on each customer?  Yes    No
Does the applicant sell/service hairpieces or wigs?  Yes    No
Is fingernail design performed in your salon?  Yes    No
If yes, describe processes:  Acryllic    Fiberglass    Silk Wrap    Gels  
   Other 
Do you store any flammable liquids in the shop?  Yes    No
If yes, describe the type, quantity and how it is used: 
Do you allow smoking in this area?  Yes    No
Names of Employees # of Years Check if # of Hours Check Items applicable: Other services Check if
(inc. Owner) Experience Part-time if part-time Perms Dyes Nails Rendered licensed
If operators are not licensed according to state regulations, explain: 
Is any space, booth or chair rented to others?  Yes    No
If Yes, give names of lessees:  
Are certificates of insurance required of lessees?  Yes    No
Do you employ students in your shop?  Yes    No
Are they salaried?  Yes    No
Do you operate a beauty/barber school?  Yes    No
Do students pay tuition?  Yes    No
Number of Instructors:     Estimated number of students graduated annually: 
Do students serve customers from the general public?  Yes    No
Are hold harmless waivers signed?  Yes    No
What processes are performed by the students: 
Are pre-disposition tests run before applying products?  Yes    No
 
 
 
_______________________________________________________ ____________________

Ritchie & Rose Insurance Services, Inc.
Bus  (530) 365-4705   Fax (866) 885-1428   DOI License No.  
0F44143


sheriritchie@gmail.com
Copyright 2006[Ritchie & Rose Insurance Services, Inc.]. All rights reserved.
Revised: 06/08/2013 04:29 PM