COMMERCIAL LINES APPLICATION

COMMERCIAL LINES APPLICATION

FARMERS INSURANCE - JOHN HADDER AGENCY
Business Information
By checking this box, you agree to receive conversational and automated text messages from John Hadder Agency LLC, DBA Farmers – John Hadder Agency. These messages may include customer service responses, policy updates, reminders, and promotional messages. Message frequency varies. Message and data rates may apply. Reply STOP to opt out at any time. Reply HELP for assistance or contact us at 205-517-8055. Consent is not a condition of purchase. See our Privacy Policy at https://www.hadder.agency/faq-1 and Terms & Conditions at https://www.hadder.agency/faq-1
Business Name
Business Owner Full Name
Business Owner Date of Birth

MonthDayYear
Date
Business Entity Type
Tax ID/FEIN (Federal Employer Identification Number)
Social Security Number (For Tax Purposes as a Sole Proprietor Entity)
Year Business Established
Business Address

Street Address

STE #, APT #, LOT #, Etc

CityState

Zip Code
Mailing Address (If Different)

Street Address

STE #, APT #, LOT #, Etc

CityState / Province

Postal / Zip Code
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Email Address
example@example.com

Workers Compensation Coverage
Do you currently have any W-2 employees?
Do you currently have any 1099 employees?
How many Full Time W-2 employees do you currently have employed?
How many Part Time W-2 employees do you currently have employed?
What is your total yearly payroll for W-2 employees?
Would you like include or exclude coverage for the owner? (Including owner coverage may cause an increase in the yearly premium)

Commercial Auto Coverage
Vehicle 1
Do you have a 2nd vehicle to add?
Vehicle 2
Do you have a 3rd vehicle to add?
Vehicle 3
Do you have any more vehicles to add?
Please include year, make, model, vin, and value for all other vehicles
Please include full name, date of birth, and driver license number for each driver to be listed on the policy

Other Business Information
Please list any other information you wish to disclose for your quote
Preferred Contact Method?
Preferred Time of Contact?
How Soon Do You Need Coverage?
Why Are You Looking For Commercial Insurance?
Would you like to receive a personal insurance quote? (Select all that apply)
Are you working with an agent already?
Most carriers will offer a discount for having previous coverage, but they will require a copy of either your current policy's Declarations Page or a copy of a current Certificate of Insurance (COI). (This is not required but does help when trying to get you the best possible rate with a carrier)

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Please upload any photos of the interior and/or exterior of the building. (This is not required but does help when trying to get your risk approved with a carrier).

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Please upload any loss runs or any other files related to your current insurance policy. (This does not apply to newly established businesses)(This is not required but does help when trying to get you the best possible rate with a carrier)

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Should be Empty:

Business Information