Other Type 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.

Service type businesses such as Dry Cleaners, Shoe Repair and Appliance Repair do present some unique insurance requirements.

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
Describe the Nature 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 that 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

MOVABLE PROPERTY

Movable property is that which frequently is off your premises. Many Service type businesses carry tools and test equipment to the customers premises. This property requires special consideration.

Business own any Movable property?	if yes, Complete Below
Briefly describe the Movable Property
Total Value

PROPERTY OF OTHERS

Service type businesses, quite often, will have temporary custody of customers property. This may be pick up or delivery or could be customers property on your premises while being cleaned or repaired. You have a special responsibility to your customer for such property.

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

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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