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Commercial Insurance Quote Request
Please answer the following questions to the best of your ability and knowledge. Your answers will help us determine the best insurance policy and coverages for your business.
Legal name of risk:
Mailing address:
City:
State:
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip Code:
Phone:
Fax number:
Email Address:
Contact name:
Describe your business:
Number of employees:
Estimated annual payroll:
Building coverage:
Yes
No
Building coverage limit:
Contents coverage:
Yes
No
Contents coverage limit:
Any commercial auto?:
Yes
No
Please indicate desired areas of coverage:
Loss of income:
Yes
No
Employee dishonesty:
Yes
No
Building ordinance:
Yes
No
Civil authority:
Yes
No
Property off premises:
Yes
No
Computers:
Yes
No
Spoilage:
Yes
No
Boiler & Machinery :
Yes
No
Liquor Liability:
Yes
No
Umbrella Coverage:
Yes
No
Employment Practices Liability:
Yes
No
Professional Liability:
Yes
No
Directors & Officers Liability:
Yes
No
Mold Coverage:
Yes
No
Terrorism Coverage:
Yes
No
Do you have any claims/losses in the past 5 years?:
Yes
No
If so explain::
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Insurance Tips
Have all polices expire on the same day
Having all policies expire on the same day lets you simplify the process of administering all your policies at the same time. It gives you the ability to have a complete picture of your program and your budget. (FYI- Insurance agents love to split up dates in order to retain the business via confusion and the hassle factor.)
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