F45 Insurance Application

Studio ID

Federal Employer ID Number (FEIN) *

Entity Name *

Assigned DBA *

Operating Principal Name *

Phone Number *

Studio Address *

Mailing Address *

The next series of fields asks for some dates in regards to your studio

Opening of Studio *

Possession of Premises *

Receipt of Package from F45 *

Build-Out Begin *

Build-Out Completion *

Building Age

# of Stories

Construction Type *

Studio Size (Sqft) *

What is the active alarm system?

Fire
Burglary
Both

Is the alarm monitored by a Central Station?

Does the studio have interior / ceiling sprinklers? *

Build-Out Budget *

Will you use a licensed General Contractor?*

Name

Phone #

Address *

Do they have Workers Comp coverage? *

Have they been in business for 5+ years? *

Do they have Liability Insurance (1 mil+)? *

Value of Personal Property in the studio *

Monthly Rent

Estimated Gross Receipts, Year 1 *

Estimated Number of Members, Year 1 *

Operating Principal Experience *

Will you use an Employee Manual? *

Will you background check all workers? *

Full-Time Employees Count *

Part-Time Employees Count *

Annual Studio Payroll, Excluding Operating Principal *

Annual Clerical/Sales Payroll

How will workers be paid?

W-2
1099

Notes / Additional Information (Max: 200 characters)

Please note that we will need a copy of your lease as soon as it is available. A draft copy of the lease can also be used since it is important that we quote to the landlord's requirements. We will also need the General Contractor/ build-out contract when available. These documents can be emailed to f45@mmibi.com at any time.

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An agent will review your application and contact you as soon as possible on the status of your request.

Thank you

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