Commercial QuotePlease fill out this form and we will get in touch with you shortly. Step 1 of 4 0% Name* First Name Last Name Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone Fax Best time to contact you? SelectMorningAfternoonEveningAnytime Your Business Information Briefly describe your business Business type Please selectCorporationPartnershipSole Proprietorship Number of owners # of full-time employees # of part-time employees # of locations Estimated Annual Payroll What is the total annual gross Business License Number License Type How long in business # Years you operated under your current business name Have you used any other business names during the past 5 years Please selectYesNo Is this business open 24 hours a day Please selectYesNo Any deeping frying (food) Please selectYesNo Is there any manufacturing, mixing, re-labeling or re-packaging of products Please selectYesNo Is there filling of propane tanks Please selectYesNo Please describe the nature of your business and ANY unusual exposures Building Property and Information Total sq. footage of the building your business is in Total sq. footage of your business only Total sq. footage of customer area only How many stories? Please select12 or more Construction type SelectBrickStoneFrameMasonrySuperiorLog cabinFrame-StuccoMasonry Veneer Type of roof covering SelectArchitectural shinglesAsphalt/Fibreglass shinglesBuilt up/Tar and gravelClay tileConcrete tileCorrugated steelMineral fibre shakesMission tileRock roofRoll roofingRubber roofSlateTinWood fibre shinglesWood shake Has the roof been updated? SelectYesNo What is the distance of fire protection? Select1000 ft. to hydrant or less or 5 miles or less to fire stationOver 1000 ft to hydrant and 5 miles or less to fire stationOver 5 and upto 10 miles to fire stationOver 10 miles to fire station Is the business in a brush area? SelectYesNo Do you have a storage area of more than 1500 sq ft.? SelectYesNo Are there smoke detectors at this location? SelectYesNo Are there fire extinguishers? SelectYesNo Are there deadbolts on all doors? SelectYesNo Are there circuit breakers? SelectYesNo Is the electrical updated? SelectYesNo Is the heating/air conditioning thermostatically controlled? SelectYesNo Is the heating/air conditioning central? SelectYesNo Has the plumbing been updated? SelectYesNo Does the building have interior automatic fire sprinklers? SelectYesNo Is there a theft alarm? SelectYesNo Is there a fire alarm? SelectYesNo Are there any restaurants in your building? SelectYesNo Are there any restaurants in the building next to your business? SelectYesNo Claims information Were there any losses or claims in the last 5 years? SelectYesNo Additional Comments Please give any additional comments or questions Which is your current insurance company? How much are you paying now? What is the liability requested? Select$100,000$300,000$500,000$1,000,000 What is the building limit requested? What is the deductible requested? Select$250$300$500$1,000$2,500 What is the business personal property (contents) limit requested? What is the contents deductible requested? Select$250$500$1,000$2,500 What is the loss of income requested? Submit No coverage of any kind is bound or implied by submitting information via this online form Information from you and other sources, such as your driving, claims and insurance histories, may be used to calculate an accurate price for your insurance. We will not distribute information to other parties other than for insurance underwriting purposes. By submitting this form, you agree to release us from any liability should this information be accidentally viewed by others. Name This field is for validation purposes and should be left unchanged.
