Business Name:
Contact Name:
Business Address:
City: State: Zip:
County:
What type of business are you in:
What type of products or services do you offer:
How long have you been in this business:
How long have you been in this type of business:
Annual company payroll:
Annual company gross sales:
Total square feet of location space:
Do you have any employees:
What are their tasks and annual payroll:
What amount of liability are you interested in securing:
What amount of business property do you need to insure:
If you are interested in a commercial auto quote, please complete the auto quote form and submit it along with this form.
Please be advised that I will need to contact you after I have received this general information from you in order to provide you an accurate quote specific to your type of business. The information requested in this is only meant to gather preliminary data, which in the future allows me to gather only the relevant information required to provide a quote.
