Commercial/Business

Commercial/Business Insurance Quote
Your Personal Data:
Your Name:
Street Address:
City:
State:
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Currently Insured?
(If yes, list carrier, and # of years continuous. If none, type NONE)
Type of Business:
Retail
Wholesale
Office
Other
Years In Business:
Business type:
(proprietorship, corporation, etc.)
Describe Business in detail:
(i.e., Delicatessen and sandwich shop, etc.)
Underwriting Information:
DESCRIBE IN DETAIL,
Your Business Operations:
OWNERSHIP & PAYROLL DATA  
List Employee’s Annual Payroll Here (if none, enter $0):
$
Insert # of
Employees here:
Coverage Desired: (Check One Please)  
The Coverage I Am Looking For:
Liability Only
Liability & Business Contents
Liability, Building & Contents Coverage
A Package Policy Including the Above, Plus Miscellaneous Coverages
Liability Coverage:
($300,000, $500,000, $1 Million, etc.)
$
Business Contents Coverage:
(The amount of your personal business property)
$
Building Coverage:
(The amount of building coverage if you own your bldg.)
$
Miscellaneous Coverage:
(List any special coverage peculiar to your business, such as Garagekeepers Legal, Loss of Earnings, Valuable Papers, etc.)
$
  NOTE: Don’t worry if you are not exactly sure about coverage type… we will suggest the best coverage for you – just try to tell us what you are looking for! (If we need more info. we will let you know.)
 
Send my quotation via:
Email
Fax
Regular mail
Call me by Phone!

 

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