SMALL BUSINESS INSURANCE QUOTE

We would like to provide you with a free, no-obligation insurance quote. Please provide as much information possible for the most accurate quote.This information will be kept confidential and will be use for quote purposes only.

Personal Information
 
Name of Business
Name of Insured
Address
City
State
Zip Code
Location Address
 (type "same" if same as above)
City
State
Zip Code
Email Address
Business Phone
Fax Number
 
Property Questions
 
Age of building/year of built
Type of building construction
Number of stories
Other occupancies

Square feet you occupy

sq. ft.
If the building is over 25 years old, please answer the following:
Year electricity was updated
Year plumbing was updated
Year heating was updated
Year building was last re-roofed
 
Protective Devices
 
Burglar Alarm



Type of alarm system
Name of alarm company
Is the building sprinklered?



Are there smoke detectors?



 
Liability Questions
 
Please provide information on previous insurance carrier
Name of previous carrier
Policy number
Prior premium
$
Policy renewal date
Please provide information about your business
Years in business
Projected gross annual receipts
$
Projected annual payroll
$

Describe your business,
product or service

 
Coverage Limits
 
Building
 $
Contents (equipment,
inventory, supplies, etc.)
$
Deductible
Loss of income
$
General Liability limit
Non-owned and Hired
Automobile Liability

Is Liquor Liability needed?



 
Additional Comments
   
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