Business Insurance Quote Form

Business Insurance Quote Form

Fill the fields below accurately and we will contact you shortly.
Contact Person

First NameLast Name
E-Mail
Email
Phone Number
Company Name
Company Name
Business Description
Business Description
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Service Details
Insurance Products You Are Interested In

General Property & LiabilityWorkers CompensationCommercial AutoInland MarineBusiness PropertyOther
Best Time to Call

Minutes

AM/PM Option
Risk State:
Business Fax
optional
Business Phone
optional
Years of Experience
optional
Years in Business
optional
Annual Gross Receipts
optional
Annual Payroll
optional
Number of Full Time Employees
optional
Number of Part Time Employees
optional
FEIN (Tax ID Number)
Other Insurance Interested in:

Auto InsuranceHomeowners InsuranceRecreational Vehicle InsuranceLife Insurance
Comments:
Current Declaration Pages/Loss Runs/Contracts

Cancelof
I understand I have the option to choose various methods of communication, and I understand the risks associated with transmission of information using the communcation methods listed below

Yes - I accept and AGREE to opt-in ** Disclaimer: By providing my contact information to Bray Agency LLC, I acknowledge and give my explicit consent to be contacted via text (SMS and MMS) and receive emails, automated telephone dialing, artificial/pre-recorded calls, video conference for various purposes, which may include marketing and promotional content. Message and data rates may apply. Message frequency may vary. Reply STOP to opt-out. Refer to our Privacy Policy for more information.No - I decline and DO NOT want to receive communication as indicated above (this does not remove me from being able to receive calls and emails regarding updates or notices on my policy)
By signing below, I agree to receive the following communications to the phone numbers(s) and email address(es) shown above, provided on behalf of Bray Agency LLC (and for all companies they represent for the purpose of all insurance and financial services they provide) and their representatives:

marketing calls
text messages (including SMS and MMS messages)
marketing emails
automated telephone dialing systems
artificial/pre-recorded voice
video conference
This agreement extends to alerts and service messages, including information on existing business and services already provided by Bray Agency LLC to my household.

My consent is not a condition of purchase.

I understand standard text message rates may apply. I will not hold Bray Agency LLC liable for any electronic messaging charges or fees generated by this service.

The frequency of these messages may vary based on the needs of my account.

I understand I will have the option to opt-out of receiving the above listed communications at any time by replying stop, or choosing the link to opt-out.

Messages/calls will be sent from:

541-779-4825

541-601-5474

Emails will be sent from authorized personal at Bray Agency LLC from a business email.

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.
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From Bray Agency LLC:

You may give permission to Bray Agency LLC employees to communicate with you by phone, text message (SMS or MMS), automated telephone dialing systems,
artificial/pre-recorded voice and video conference. This form provides information about the risks of these forms of communication, guidelines for phone, text, email, automated telephone dialing systems, artificial/pre-recorded voice and video conference communication, and how we use these forms of communication. This form will also be used to document your consent for communication with you by phone, text message (SMS or MMS), email, automated telephone dialing systems,
artificial/pre-recorded voice and video conference.

1. Risks of using phone and/or texting: The transmission of information by phone and/or texting has a number of risks that clients should consider prior to use. These include, but are not limited to, the following risks:

A. Phone calls, voicemails, and text messages can be circulated, forwarded, stored electronically and on paper, and broadcast to unintended recipients.
B. Text senders can easily misaddress a text and send the information to an undesired recipient.
C. Backup copies of texts may exist even after the sender and/or the recipient has deleted his/her/their copy.
D. Phone calls, voicemails, automated telephone dialing systems,
artificial/pre-recorded voice, and texts can be intercepted, altered, forwarded, or used without authorization or detection.
E. Voicemails and texts can be used as evidence in court.
F. Phone calls, voicemails, and texts may not be secure. Therefore, the confidentiality of such communications may be breached by a third party.
2. Conditions for the use of phone, voicemail, and text: Bray Agency LLC and their employees cannot guarantee but will use reasonable means to maintain the security and confidentiality of phone, voicemail, and text information sent and received. Bray Agency LLC and their employees are not liable for improper disclosure of confidential information that is not caused by the Orangewood Foundation and their employees’ intentional misconduct.

Clients/Parents/Legal Guardians must acknowledge and consent to the following conditions:

A. Bray Agency LLC and their employees cannot guarantee that any particular text or voicemail will be responded to within a specific amount of time. Bray Agency LLC and their employees will respond during regular business hours to text messages and voicemails in a reasonable time, unless otherwise specified. Voicemails and text messages may not be answered outside of business hours or on the weekends/holidays.
C. Text communication and transcribed voicemails may be printed and filed into the client’s record.
D. Bray Agency LLC and their employees are not liable for breaches of confidentiality caused by the client or any third party.

Bray Agency LLC may also use a specialized video-conferencing services, such as Microsoft Teams, or Zoom (NOT HIPPA or HITECH protected), for video and audio conferencing and chat. There is always a risk when using internet-based communication, as it cannot guarantee 100% security and confidentiality.
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Business Insurance Quote Form

Service Details