Artisan Contractors Form

Artisan Contractors & Subcontractors Intake Form

Programs available through Farmers and Farmers Affiliates and Partners
Business Owner Name

First NameLast Name
Email
example@example.com
Owner Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone for SMS Text Messages
Please enter a valid phone number.Format: (000) 000-0000.
Business Name
Business Type
Business Address

Street Address

If your Business is located at your Home, put your address in the field above

CityState

Zip Code
Year Business Was Established
Business FEIN or UBI
Estimated Business Revenue (Annual)
will be required to quote
Have you had any insurance claims in the last 3 years? If so, how many claims?
Which of the following do you also need:
Current Carriers, Coverage, & Expiration Dates
Provide a Brief Description of your Business Operations & Anything you may currently be having issues finding coverage for, if applicable.
Number of Part-Time Employees (Not including Owner)
Number of Full-Time Employees (Not including Owner)
Gross Annual Revenue
Total Annual Payroll (Excluding Owners)
What Type of Construction Related Work do you Perform:

Other
Which Insurance Quotes or Renewals are you looking to secure through Farmers and our Affiliate Partners

Other
If you have any questions, please detail below. You should be contacted by one of our Business Insurance Agents within 48 hours after submitting this form
Referring Farmers Agent:
Enter the name of the Agent you've been working with or who sent you this link
Please Upload your Current Policy Docs and/or Loss Runs to Expedite Quoting or Renewals

Cancelof
Please verify that you are human
Should be Empty:

Artisan Contractors & Subcontractors Intake Form