General Liability Quote Request
Please fill out as detailed as possible to ensure the most accurate and fast quote possible.
Business Name
*
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
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*
Yes
No
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your mailing address the same as your business's physical address?
*
Yes
No
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this a new venture?
*
Yes
No
How long have you been in business?
*
Prior Insurance Information. Please request your loss runs from your prior agent/carrier. They will be required in order to get you a firm quote!
*
Provide information such as: Who were you insured with, effective dates & premium amounts.
What is the nature of your business? Describe in detail what it is you do. What is a typical work day for you. Office work, Transportation, Construction Etc
*
Describe in detail what it is you do. What is a typical work day for you. Office work, Transportation, Construction Etc
What are your estimated gross annual sales?
If not applicable put N/A
What is your estimated employee payroll?
If not applicable put N/A
What is your estimated annual subcontractor costs?
If not applicable put N/A
Do you have an office space/building? If yes, what is the square footage.
If not applicable put N/A
If you are a transportation service how many units do you have.
Do you know what kind of limits you would like?
*
Please Select
1 million / 2 million
Less than 1 million / 2 million
More than 1 million / 2 million
I don't know
Do you have employees or subcontractors?
Employees
Subcontractors
Both
None
Have you had any claims/losses?
Yes
No
Describe in detail what happened in the claim/loss, and the date it occurred
How many Employees/Subcontractors do you have? Are they full or part time?
# of Full time/Part time?
Do you need any Mortgagees or Additional Insured's added to your policy?
Mortgagee
Additional Insured
Both
None
List Name, Address & Contact info for any Mortgagee/Additional Insureds.
Any additional information we need to know to quote:
How did you hear about us?
Please Select
Current Client
Google
Our Website
Referral : Let us know who referred you in the notes.
Other : Please describe in the notes
I attest that the information I provided is accurate, and understand that the quotes BIG provides to me will be based off this information:
Yes
No
Thank you for your submission! We will be in touch shortly.
Submit
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