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Step 1 of 4 - Your Personal/Company Information
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Address
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Street Address
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Currently Insured
*
Please Make A Selection
Yes
No
(If yes, list carrier, and # of years continuous. If none, type NONE)
Type of Business
*
Please Make A Selection
Retail
Wholesale
Office
Other
List Claims & Amounts Paid
*
(If none, type NONE)
Years In Business
*
Business type (proprietorship, corporation, etc.)
*
Describe Business in detail (i.e., Delicatessen and sandwich shop, etc.)
*
Underwriting Information
Describe IN DETAIL, Your Business Operations
Ownership & Payroll Data
List Employee's Annual Payroll Here (if none, enter $0): $
Insert # of Employees here
Location & Sales Information
Insert Annual Gross Revenues from this operation here
Square Footage of office or business location
Type of Building (wood frame, concrete, etc.)
Number of Stories
Are there other business/residences in this building (describe)?
Describe safety features (alarm, sprinklers, fire protection, etc)
Coverage Information
What Type of Coverage Are You Looking For
Please Make A Selection
Liability Only
Liability & Business Contents
Liability, Building & Contents Coverage
A Package Policy Including the Above, Plus Miscellaneous Coverages
NOTE: Don't worry if you are not exactly sure about coverage type... we will suggest the best coverage for you - just try to tell us what you are looking for! (If we need more info. we will let you know.)
Liability Coverage: ($300,000, $500,000, $1 Million, etc.)
*
Business Contents Coverage: (The amount of your personal business property)
Building Coverage: (The amount of building coverage if you own your bldg.)
*
Miscellaneous Coverage: (List any special coverage peculiar to your business, such as Garagekeepers Legal, Loss of Earnings, Valuable Papers, etc.)
*
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E-Mail
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Regular Mail
Please Call by Phone!
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Get A Quote
Personal Insurance
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Homeowners Insurance
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Personal Umbrella Insurance
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Business Insurance
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Workers Comp Insurance
General Liability Insurance
Commercial Umbrella
Employee Benefits
Special Contractor Policies
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