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Business Insurance Quote
Home
Business Insurance Quote
E&S Bonded and P&C Licensed
A Rated Insurers and Specialty Markets
Business Insurance Quote
Sheldon Altschuler
2024-12-05T15:59:16-05:00
"
*
" indicates required fields
Step
1
of
7
14%
Business Name
*
Entity Type
*
- Select -
Sole Proprietorship
S Corporation
C Corporation
LLC
Partnership
Joint Venture
Trust
Association
Municipality
Other
NAICS Code (if applicable)
Does the business have an FEIN?
*
Yes
No
FEIN
*
Business Location
The business is operated out of
*
- Select -
My home
An apartment
A building I lease
A building I own and run my business out of
A building I own/manage and lease to others
A commercial condo I own
A commercial condo I lease
A kiosk
Business Address
*
Street Address
Address Line 2
City
- Select State -
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Business occupied square feet
*
Building total square feet
Building number of stories
Does the building have sprinklers inside?
Yes
No
Is the building owned in the name of the business?
Yes
No
Business Information
Year Business Established
*
Years of Experience In This Field
*
Does the business currently have insurance in force?
*
Yes
No
Is the business in operation year-round?
*
Yes
No
Number of Full Time Employees
*
Number of Part Time Employees
*
Sales and Payroll
Estimated Gross Annual Revenue
*
Estimated Annual Payroll (Owners)
*
Estimated Annual Payroll (Employees)
*
Estimated Annual Payroll (Subcontractors)
*
Policies and Coverages
Preferred Policy Start Date
*
MM slash DD slash YYYY
Policy Interests
*
Select all that apply.
General Liability
Workers Compensation
Business Owners Policy
Commercial Auto
Professional Liability
Cyber Liability
Umbrella
Commercial Flood
Other/Not Sure
Value of Business Personal Property
Does anyone need to be listed as Additional Insured?
*
Yes
No
Any business losses or claims in the last 5 years?
*
Yes
No
Has coverage been cancelled, declined, or non-renewed in the last 3 years?
*
Yes
No
Was cancellation for non-payment?
*
Yes
No
Primary Contact
Primary Contact Name
*
First
Last
Email
*
Phone
*
Can we text you?
Yes
No
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Wrapping Up
Consent
*
Like most insurance agencies, we use information from you and other sources, such as your driving and claims histories, insurance score, and other factors to calculate an accurate rate for your insurance. New or updated information may be used to calculate your renewal premium.
I Agree
All the above information is accurate and true to the best of my knowledge.
*
Yes
Signature
*
Date Today
MM slash DD slash YYYY
Comments
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