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General Information

First Name:
Middle Name:
Last Name:
Date of Birth:
Marital Status:
Address:
City:
State:
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Email:
Day Phone:
Evening Phone:
Best time to call:
Business Information
Name of Business:
Is this a corporation?
Number of Owners:
Business Location:
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State:
Zip:
Type of Business:
Description of Operations:
How many years in business?
How many years of experience?
Estimated gross sales for the previous year:
Estimated gross sales for this year:
How many employees?
Amount of payroll per year:
Are subcontractors used?
Any claims in the past 3 years?
Work Description
Residential: %
Commercial: %
Any roofing work?
Other Information
What licenses held?
In what states do you operate?

About Us

Lakewood Center Office

Phone: (540) 972-7981

Fax: (540) 972-3345


Fredericksburg Office

Phone: (540) 548-1491

Fax: (540) 548-1492

Catherine A. Fanning, LUTCF
CEO / Personal Lines Agent
Ext. 206
caf@fanningandassoc.com


Brian Downs
Life / Health Specialist
Ext. 207
brian@fanningandassoc.com


Sharon Hunsberger
Accounting Department
Ext. 202
sharon@fanningandassoc.com

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