Commercial_Insurance_Quote

Smart Commercial Insurance Quote Assistant
Business Name
Business Owner Name
Business Phone
Email
example@example.com
Business Address
Website if any
Years in Business
Number of Employees
Industry Type
Business Description products/services
Do you have commercial vehicles? [] Yes [] No

Do you have a physical location open to the public? [] Yes [] No

3. Coverage Needs What types of commercial insurance are you interested in? (Check all that apply)

[] General Liability

[] Commercial Property

[] Business Owner's Policy (BOP)

[] Workers' Compensation

[] Commercial Auto

[] Professional Liability (E&O)

[] Cyber Liability

[] Product Liability

[] Commercial Umbrella

[] Other:

Do you currently have business insurance? [] Yes []No
Current Insurance Carrier
Policy Expiration Date

MonthDayYear
Date
How did you hear about us? [] Referral [] Website [] Social Media [] Other
Any additional details or questions
6. Marketing Permission Would you like to receive updates, exclusive offers, and helpful business tips from Adams Agency?

[] Yes, sign me up for emails and texts

[] No, I prefer not to receive marketing communications

I authorize Adams Agency AI Agent to contact me regarding my quote request.

[] Yes
Signature

Clear
Date

MonthDayYear
Date
Should be Empty: