Auto Business Quote Request

Business Insurance is quite complex. We give you the choice of continuing with this form or choose our Quick Form for your convenience. If you choose our Quick Form we will contact you for all the required information.

COMPANY INFORMATION

Note- Coverage can not be bound or altered by this submission
Company name
Contact name
Address

City
State
Zip
Daytime telephone number
Alternate telephone number
Email address *
Legal Entity
Number Of Employees
Your Primary Business
Describe Other Aspects Of Your Business

REAL ESTATE OWNED

Does your company own any Real Estate?	if yes, Continue
Is its location the same as your Company address?	if No, complete below
Street Location of the Property
City & State
Zip

Type of Construction
Sprinklered
Security System
Describe the Type of Building
Describe All Occupancies

PERSONAL PROPERTY OWNED

Personal Property is property (other than autos) is kept at a fixed location.

Do you own any personal property?	if yes, Continue
Its location the same as Company address?	if No, complete below
Street Location of the Property
City & State
Zip

Sprinklered
Security System
Describe the Type of Building
Describe All Occupancies

OWNED AUTOS HELD FOR RESALE

Total Value of Owned Autos Held for Resale

MOVABLE PROPERTY

Movable property is that which frequently is off your premises. Some repair businesses take tools and equipment off site to do maintenance and repairs. This property requires special attention.

Do you have such property?	if yes, Complete Below
Briefly describe the property
Total Value

AUTOS OWNED BY OTHERS IN YOUR CARE

Autos owned by others and left in your care for repairs etc. present unique exposures and must be insured differently.

Total Value of Customer Cars

DESIRED COVERAGES

Building Amount
Contents Amount
Loss of Income
Deductible
Limit of Liability
Describe Other Coverages Desired
Desired Effective Date

CURRENT POLICY INFORMATION

Renewal Date
Insurance Company
Current Premium
Describe any Losses in the Past 5 Years

COMMENTS

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