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WE PROUDLY REPRESENT
ONLINE QUOTE FORM
Commercial Building Property Insurance Quote
First & Last Name:
Location Street Address:
City, State & Zip:
E-Mail Address:
Telephone:
Fax:
Business Name:
Insurance Company Name:
Policy Exp. Date:
Any Claims in Last 3 years?
(if Yes, please describe)
Do you carry work comp for your managers?
Please select..
Yes
No
Property Information
Address (if different):
Year Built:
Protection Devices:
Please select..
Central Alarm
Smoke Detectors
Fire Extinguisher
Sprinklers
Any Updates to Property?
(if Yes, please describe)
Complete Lender Info.
ie Escrow Info if new purchase
Building Information
Units:
How many Stories?:
# of buildings:
Flood Insurance?
Please select..
Yes
No
Electrical Type:
Construction Type:
Please select..
Wood Frame
Steel
Mill
Concrete
Total Sq. Ft. of building (s):
Earthquake Insurance?
Please select..
Yes
No
Building Value:
Contents Value:
How did you hear about us?
Select
Referral
Internet Search
Google
Yahoo
Bing
Flyer/Brochure
Phone Book
Radio Spot
Other
Please give a detailed description of you business and operations:
Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.
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241 E. Kern Ave. Tulare, California 93274 |
Phone: 559-688-7711
| Fax: 559-688-7716 |
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1800 Leoni Dr. Hanford, CA 93230 | Phone: 559-584-6020 |
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