Commercial Insurance Quote

Business Official Registered Name (if not registered yet, put proposed name) *

Business Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Email *

Business Website

# of years in business

Number of Owners *123

Name (owner #1) *

First

Last

# of years of experience in this industry (owner #1) *

Date of Birth (owner #1) *

Name (owner #2) *

First

Last

# of years of experience in this industry (owner #2) *

# of years of experience in this industry (owner #2) *

Name (owner #3) *

First

Last

# of years of experience in this industry (owner #3) *

# of years of experience in this industry (owner #3) *

Please provide a description of what type(s) of work is done by the business *

What type of insurance do you need (check all that apply) *

• General Liability
• Commercial Auto
• Worker’s Comp
• Commercial Building/Office
• Other
• I’m not sure

Do you have a current commercial auto policy in force? *

• Yes
• No – This is a new business
• No – Didn’t have coverage

When does your current policy run out?

What is your expected annual gross sales (if a new venture, please estimate) *

Do you sub out any work?NoYes

What percentage of work is subbed out?

What type of work do you sub out?

How many commercial autos do you need to insure?

• 1
• 2
• 3
• 4+

How many full time employees do you have?

What is annual gross salary for all full time employees (not including owners)

How many part time employees do you have?

What is annual gross salary for all part time employees (not including owners)

How many commercial locations do you need to insure?

• 1
• 2
• 3+

Address of location #1

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Do you own or lease this location?

• Own
• Lease

Address of location #2

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Do you own or lease this location?

• Own
• Lease

Submit