Logging/Lumber Industry Quote Request

1
Name* This field is required.
First Name
Last Name
2
Submission Counter
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Phone Number* This field is required.
Area Code
Phone Number
4
Email Address* This field is required.
5
What is the name of your business?* This field is required.
6
Physical/ Street Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
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Country
7
Is the mailing address the same as physical address?* This field is required.
YN
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Mailing Address:* This field is required.
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Mailing City:* This field is required.
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Mailing State:* This field is required.
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Mailing Zip Code:* This field is required.
12
What type of insurance are you looking for?* This field is required.
Property Insurance
Auto Insurance
General Liability Insurance
Umbrella & Excess Liability Insurance
Workers' Compensation
Employee Benefits & Health Insurance
401(k) & Other Financial Services
I'm not sure...
13
Please indicate your current annual insurance premium (estimate)* This field is required.
No insurance currently in place
Below $10k per year
Between $10k and $50k per year
More than $50k per year
14
is this for a new or existing business?* This field is required.
New business
Existing business
15
What type of business is it?* This field is required.
Logging operation
Sawmill (stationary)
Sawmill (portable)
Log trucking
Other/combination of above
16
Please describe your business* This field is required.
17
Estimated gross annual revenue? (if new business, enter your projected revenue)* This field is required.
18
Number of employees?* This field is required.
19
Estimated annual payroll?* This field is required.
20
Please indicate your current insurance situation* This field is required.
Don't have insurance
Have insurance, but am looking to increase coverage and/or lower cost
21
Ok great. Would you like to upload your current insurance declarations page? It's optional, but streamlines the whole quoting process saving you time.* This field is required.
Sure, I'll upload it.
I'd rather enter info manually.
22
Please upload the declarations page of your current policy below.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
23
Who are you currently insured with?
24
How many years have you been with your current insurance company?
25
Any claims filed within the last 3 years?* This field is required.
YESNO
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No problem. Please give a brief summary of the claim(s).
Huge
Large
Normal
Small
Ok
Ok
27
Now we need to gather some information about your vehicles & equipment. Would you like to enter this manually or upload a schedule of these items?* This field is required.
Enter manually
I'll upload (or email) a schedule to you
28
Great! Please upload your vehicle & equipment schedule below:
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
29
Please list out your equipment/vehicles. Include:Year - Make - Model - Value - Serial Number (if possible)Tip: If on a computer, start a new line by pressing "enter" while holding the "shift" key
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Ok. Now for buildings. Are there any buildings or property that needs to be insured?* This field is required.
YN
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Would you like enter info on the property manually or upload a schedule of the property?
Enter manually
I'll upload
32
Great! Please upload the property schedule below:
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
33
Ok, please enter: 1) The building's value, 2) Value of the contents of the building, 3) Whether the building is pole framed (wood) or steel framed* This field is required.
Huge
Large
Normal
Small
Ok
Ok
34
Anything else you want us to know about the equipment or property of your business?(optional)
35
Now, for driver information. Do you have any drivers of vehicles owned by your business?* This field is required.
YN
36
Would you like to enter driver information manually or upload a schedule of these items?* This field is required.
Enter manually
I'll upload (or email) a schedule to you
37
Great! Please upload the driver schedule below:
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
38
Alright. Please list out drivers and include the following (to the best of your ability) Name - Date of birth - License number* This field is required.
39
Any other documents you need to upload? Please upload here.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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What made you start shopping for insurance today?* This field is required.e.g. cost savings, better protect your assets, reduce liabilities, insurance required for a job or vehicle purchase, etc.
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Last question, and its an easy one. How did you find us?* This field is required.
Referral/word of mouth
Online search
Radio ad
Print ad
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