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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* PhoneFaxBest time to contact you?SelectMorningAfternoonEveningAnytime Your Business InformationBriefly describe your businessBusiness typePlease selectCorporationPartnershipSole ProprietorshipNumber 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 yearsPlease selectYesNoIs this business open 24 hours a dayPlease selectYesNoAny deeping frying (food)Please selectYesNoIs there any manufacturing, mixing, re-labeling or re-packaging of productsPlease selectYesNoIs there filling of propane tanksPlease selectYesNoPlease describe the nature of your business and ANY unusual exposures Building Property and InformationTotal 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 moreConstruction typeSelectBrickStoneFrameMasonrySuperiorLog cabinFrame-StuccoMasonry VeneerType of roof coveringSelectArchitectural shinglesAsphalt/Fibreglass shinglesBuilt up/Tar and gravelClay tileConcrete tileCorrugated steelMineral fibre shakesMission tileRock roofRoll roofingRubber roofSlateTinWood fibre shinglesWood shakeHas the roof been updated?SelectYesNoWhat 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 stationIs the business in a brush area?SelectYesNoDo you have a storage area of more than 1500 sq ft.?SelectYesNoAre there smoke detectors at this location?SelectYesNoAre there fire extinguishers?SelectYesNoAre there deadbolts on all doors?SelectYesNoAre there circuit breakers?SelectYesNoIs the electrical updated?SelectYesNoIs the heating/air conditioning thermostatically controlled?SelectYesNoIs the heating/air conditioning central?SelectYesNoHas the plumbing been updated?SelectYesNoDoes the building have interior automatic fire sprinklers?SelectYesNoIs there a theft alarm?SelectYesNoIs there a fire alarm?SelectYesNoAre there any restaurants in your building?SelectYesNoAre there any restaurants in the building next to your business?SelectYesNo Claims informationWere there any losses or claims in the last 5 years?SelectYesNoAdditional CommentsPlease give any additional comments or questionsWhich is your current insurance company? How much are you paying now? What is the liability requested?Select$100,000$300,000$500,000$1,000,000What is the building limit requested? What is the deductible requested?Select$250$300$500$1,000$2,500What is the business personal property (contents) limit requested? What is the contents deductible requested?Select$250$500$1,000$2,500What is the loss of income requested? SubmitNo 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. NameThis field is for validation purposes and should be left unchanged. Δ
