Commercial Insurance Quote

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Commercial Insurance Quote

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                                                                *  Required Field

General Information

  Contact Name


If you are in the Construction Trades

use this form ---> Contractor Quotes


Contractors DO NOT use this form page

as we may not be able to process your

quote request.



  Business Name


  Street Address (Not PO Box)






  County *



  Business Phone



Current Insurance Company

  Company Name
  Policy Expiration Date

Current Insurance Coverage

  Current Coverage


Commercial Auto

Commercial Liability

Commercial Property

Commercial Umbrella

Directors & Officers Liability


Group Health

Group Life

Professional Liability

Workers' Compensation


Business Information

  # of Full-Time Employees            *
  # of Part-Time Employees           *
  How long in Business? (yrs) *
  How many locations?  

  Please give a brief description of

  your  business and Clientele


Only fill this portion if you need property coverage. If No property coverage is required skip to next Section

Property/Premises Information

Address      to be insured

  Occupancy Status

Owner  Tenant

  Year Built

  % Occupied


Yes  No

  Construction Type


  Sq. Footage

  Burglar Alarm

Yes  No

  Building Value


  Other Property (specify)

Limits Requested

Annual Gross Sales: (before taxes)   


Annualized Payroll 


Percent of work Subcontracted


Liability Limits Requested

*$100,000 $300,000$500,000 $1,000,000 $2,000,000

Describe any claims you've had in the past 5 years

Additional Comments, information. You

may also ask questions in this box.

Disclaimer Notice - The premiums quoted are estimates based on information you provided. If you have question or other pertinent information you feel is necessary to properly quote your Insurance, Please feel free to call our office for a personalized free quote.

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