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Annuities, Life Insurance, Long Term Care experts!
Commercial Quote- EZ Form- Please fill out below
The field marked with (*) are required fields.
*
Business Name
*
Business Street Address
*
City & State
*
Zip
Are you a building owner?
[Select One]
Owner
Tenant
*
Type of Business: (Ex. Restaurant, Drywall, Flowershop & etc)
Deductible
[Select One]
$100
$200
$500
$1000
$2500
$5000
other
If insuring building or office- year building was built? (Approximate)
Does office and/or building have an alarm sytem?
[Select One]
Yes
No
If insuring office/building, is there a sprinkler sytem?
[Select One]
Yes
No
*
Business Inception Year (Ex 1995)
*
Number of paid insurance claims in the last 5 years?
[Select One]
None
1
2
3 or more
Insurance- If insuring building/office- what amount of building coverage? (Ex $330,000)
Insurance- What is the value of the contents of the business? (Ex- $50,000, $60,000 & etc)
Insurance- Liability Limits?
[Select One]
$500,000/$1 Million
$1 Mil/$2 Million
$1 Mil/$3 Million
Other
*
Contact- First Name
*
Last Name
*
Position (Ex Owner, & etc)
*
Business Phone
Cell Phone or Home Phone
Fax Number
E-Mail
