August 12, 2022
COMPANIES
WHO WE ARE
LOCATIONS
OUR STAFF
CONTACT US
WHAT WE DO
AUTO INSURANCE
QUOTE
FAQ's
HOMEOWNERS INSURANCE
QUOTE
FAQ's
FARM INSURANCE
COMMERCIAL INSURANCE
QUOTE
FAQ's
LIFE INSURANCE
QUOTE
ONLINE LIFE QUOTE - EMC NATIONAL LIFE AND LEGAL
CALCULATE YOUR LIFE INSURANCE NEEDS
FAQ's
GET AN UNOFFICIAL OHIO DRIVING RECORD FOR FREE
GET A QUOTE
AUTO
HOME
BUSINESS
TRAVEL MEDICAL INSURANCE
LIFE
ONLINE LIFE QUOTE - EMC NATIONAL LIFE AND LEGAL
CALCULATE YOUR LIFE INSURANCE NEEDS
CLAIMS REPORTING
CLIENT RESOURCES
CONTACT US
REQUEST A CHANGE
AUTO ID REQUEST
REQUEST CERTIFICATE OF INSURANCE
CAREERS
Business Quote
General Information
Contact Name *
Email *
Business Name
Address
City
State
Zip
County
Business Phone
Fax
Current Insurance Company
(not agency)
Company Name
Policy Expiration Date
Current Insurance Coverages
Current Coverages
Bond
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
Disability
Group Health
Group Life
Professional Liability
Workers' Compensation
Other
Business Information
# of Full-Time Employees
# of Part-Time Employees
How long in Business? (yrs)
How many locations?
Please give a brief description of your business and clientele
Property/Premises Information
Address
Occupancy Status
Owner
Tenant
Year Built
% Occupied
Sprinklers
Yes
No
Construction Type
Frame
Brick Veneer
Stucco
Metal
Concrete
Stories
# Basements
Sq. Footage
Burglar Alarm
Yes
No
Building Value
Contents
Other Property (specify)
Insurance Information
Other
Annual Gross Sales: (before taxes)
Number of Employees
Annualized Payroll
Cost of any Subcontracted Work
Limits Requested
$300,000
$500,000
$1,000,000
$2,000,000
Describe any claims you've had in the past 5 years
Additional Comments
* = Required Field
Disclaimer Notice
- The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
Send