Gordon Insurance - Request a Commercial Insurance Quote

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
Phone#
Fax#
Email
Describe your business
Number of Employees
Estimated Annual Payroll
Bldg Coverage	Yes No Limit
Contents Coverage	Yes No 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: