South Mountain Services
2030 W Baseline Rd Ste 182-510
Phoenix AZ 85041
602-601-7404
Business Insurance Quote Request
Please complete this entire form in order to receive the best service. We will shop insurance rates from over a dozen top rated insurance carriers. You can expect to hear back from us asap via phone, email and text message.
Business Name:
*
What type of Business Insurance do you need?
*
General Liability (most common)
Property
Workers Compensation
Professional Liability
Errors and Omission
Builders Risk
Vacant Land
Directors and Officers
Commercial Auto
Commercial Umbrella
Trucking Insurance
Your Name:
*
Prefix
First Name
Last Name
Business Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Is the business address the same as the mailing address?
Yes
No
Mailing Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
-
Area Code
Phone Number
E-mail:
*
EIN (Employer Identification Number):
Business Formation:
*
Sole Proprietorship
LLC
C-corp
S-corp
Nonprofit Corporation
Unsure
If you are unsure don't worry, we can help with this
Does your business have a physical location?
Yes
Yes with multiple locations
No
Online Store
Sorta, I work from home
I need this for a Farmers Market
Do you require any of these insurance filings?
Federal (ex: BMC 91X)
State (ex: Form E)
Both Federal and State
No filings are needed
Farthest one-way distance this vehicle travels:
50
100
200
500 or more
VIN:
*
What is the body type of this vehicle:
*
Straight or Box Truck
Tractor
Cargo Van
Delivery or Step Van
Pickup Truck
Dump Truck
Limousine
Other
What type of cargo best describes your hauling operation:
*
Autos, RVs, Trailers, Boats
Garbage
Gas, Oil, energy related
Household goods, moving operations
Hazardous materials
Sand and gravel
Other
What is the Vehicle's Value:
Value of permanently installed equipment:
USDOT Number:
Do you need at least $100,000 in cargo coverage?
*
Yes
No
Do you have a Trailer?
No
Yes
Yes, a non-owned trailer that I lease
Types of coverages (select all that apply)
Cargo
General Liability
Trailer Interchange
Bobtail Insurance
Comprehensive and Collision
Hired Car / Non Owned (leasing your business vehicle)
Liability Coverage needed:
$750,000 or less
$1,000,000 or more
Drivers Full name
*
First Name
Last Name
Drivers License Number:
*
Drivers License State:
*
Drivers Date of Birth:
-
Month
-
Day
Year
Date
Year that Business started:
*
2015
Are you currently insured?
Yes
No
Annual Gross Sales:
*
Annual Payroll:
Number of Employees (including yourself):
*
Square footage of occupied facility:
Does your location have fully functioning sprinklers
Yes
No
Amount of Business/Personal property coverage needed:
Enter your website address:
Contractor License Number:
Will you require an Additional Insured to be listed
Yes
No
Landlords often require their name to be listed on the policy as an Additional Insured
Has your business filed an insurance claim in the last 3 years?
Yes
No
If cost is important, how much do you currently pay?
*
ex: $1500
Payment frequency:
Monthly
Annually
Other
Tell us about your business. What goods, services or causes do you offer?
Upload Your Current Insurance Policy
Browse Files
This gives us the opportunity to compare coverage/cost. It's all about you winning!
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Are there any other items that you would like us to keep in mind? (additional drivers, more VINs, trailers, etc...)
*
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