Business Insurance Quote

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Business Insurance Quote

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Complete the form below for your free, no obligation quote. The more detail you provide the faster we can prepare options for you.
If you prefer to speak with us call 800-537-7843 or click here to submit a call back request.

Name(Required)

First Last

Phone

Email(Required)

Address

Street Address Address Line 2 City State ZIP Code

The selections you make here will determine what data is collected in the following steps.
If you prefer to speak with us call 800-537-7843 or click here to submit a call back request.

Which policies are you interested in?

Business Owners Policy

General Liability

Business Property

Business Auto

Workers Comp

Professional Liability

Cyber

Umbrella

Flood

I'm not sure

General Information

About the business

Business Name(Required)

DBA

FEIN

Year business started\acquired

Website

Do you currently have insurance?

Yes

Has any insurance coverage been cancelled, declined or non-renewed in the past 3 years?

Yes

Does your business operate out of your home?

Yes

Annual Revenue

Number of employees

Please describe what your business does

If you prefer to speak with us call 800-537-7843 or click here to submit a call back request.

Not Sure?

That's ok. go ahead and skip this step and enter any notes or comments on the next screen. We'll reach out shortly to discuss your needs and provide a recommendation.

Workers Comp Section

Would you like to include or exclude officers from coverage?

Include

Exclude

Does your business operate in more than one state?

Yes

If yes, which states do you operate in?

Total Annual Payroll

Employee Breakdown

In order to provide an accurate quote we will need a breakdown of the # of employees performing each job function and total annual payroll for each class. For example:

2 Office workers - $60k
6 Laborers - 240k
1 Manager - 60k

Liability Coverage Section

Any claims in the past 5 years?

Yes

Please describe your claim(s)

Do you have more than one location?

Yes

Location Information

Occupied square footage

Year built

Number of stories

Sprinkler System?

Yes

Alarm System?

Yes

Since you have multiple locations please upload a file listing each location with the following information:

Occupied and total square footage
Year built
Number of stories
Own or rent
Sprinkler system
Alarm system
Value of building (if owned)

Any format is acceptable

Max. file size: 100 MB.

Cyber Coverage Section

Do you process or store Personally Identificable Information for more than 1000 individuals?

Yes

Do you have a security strategy in place? (i.e. backups, firewall, encryption, MFA etc.)

Yes

Please describe your security controls

Has your business experienced a cyber hack, breach or claim in the last 5 years?

Yes

Business Property Section

Building Coverage

Do you want to insure your building(s)?

Yes

Do you have more than one building to insure?

Yes

Total building square footage

What is the age of the roof?

Does the business own the building?

Yes

Estimated value of the building (not including land)

Provide a brief description of the building

Please upload a list of buildings including:

Square footage
Year Built
Number of stories
Own or rent
Sprinkler system
Alarm system
Value of building

File Upload

Max. file size: 100 MB.

Contents Coverage

Include coverage for contents? (furniture, equipment, supplies etc)

Yes

Value of contents

Any high value or unique items?

Yes

Please describe the item(s)

Business Auto Section

Have you had an auto accidents or claims in the last 5 years?

Yes

If yes, please describe

Do you need to insure more than one business vehicle?

Yes

Vehicle Information

Please upload a list of vehicles including:

VIN number
Year
Make
Model
Driver(s)
Vehicle purpose\use

File

Max. file size: 100 MB.

VIN

Year

Make

Model

Driver(s)

What is this vehicle used for?

Is this a lease?

Yes

Is there a loan on this vehicle?

Yes

Who is the lessor\leinholder?

Driver(s)

Include a driver other than me?

Yes

My License #

My License State

Additional Driver 1

Driver 1 Name

Driver 1 License #

Driver 1 License State

Add another driver?

Yes

Additional Driver 2

Driver 2 Name

Driver 2 License #

Driver 2 License State

For more than 2 additional drives please add a note on the next page

Anything else we should know?

Comments

This field is for validation purposes and should be left unchanged.

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