Commercial Insurance Quote

Commercial Insurance Quote
Select Lines of Business*
When do you need your coverage to begin?*

MonthDayYear
Date
How did you hear about us? *
Google, Yelp, Facebook, Instagram, Radio Ad, Friend, Agent etc.
Agent who referred you (If applicable)
Business Information
Business/Organization Name (Exact Name Needed)*
Organization's DBA (If applicable)
Business Entity Type *
Date Business Started*

MonthDayYear
Date
Federal ID Number (FEIN)
Years of Management Experience*
Details regarding insured's management experience.*
Business Location Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Area Occupied in Square Feet*
If the insured is a building owner, the area provided should represent the total square footage of the building. If the insured is a tenant, the area provided should represent the area associated only with their operation.
How many years has the applicant been in the current location? *
Mailing Address (If different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the insured currently have an in-force policy?*

YesNoUnknown
If Yes; Expiring Carrier Name
Website Address
Number of Employees*
Must include at least 1 employee.
Number of Full Time Employees*
Number of Part Time Employees
Number of Managers, LLC Members and Executive Officers*
Estimated Total Annual Payroll*
Estimated Total Annual Revenue*
If this is a new entity, please put expected annual revenue.
Description of Operations - Please Be Specific (10 words or more)*

0/0
Contact Information
Contact Name*

First NameLast Name
Date of Birth

MonthDayYear
Date
Contact Phone Number *
Contact Email Address*
example@comfortif.com
Year Business Established (YYYY)
Coverage Information
Liability Limits Desired*
Deductible Limits*
Supplementary Information
Is there any foreign travel or does the business conduct any international transactions?*

YesNo
Did this business have any claims or losses in the last 3 years?*

YesNo
If Yes: Please Describe Details of Loss
Date, Line of Business, Cause of Loss, Claim Status, Benefit amount received or reserved, State Loss Occurred
Has the insured been non-renewed or cancelled during the past three years for any of the following reasons?*

2 or more non-payments in the past 3 years1 Non-Pay in the past 3 yearsCarrier withdrew from a class or line of business or stateTermination of agency with another carrierOtherClaims of Loss ExperienceNo
Which of the following applies to you?*

I am engaged in other types of businessI provide group transportationMy employees travel out of state (specify states under notes)I use Sub-Contractors (give % if work subcontracted under notes)I use 1099 LaborNone of the Above
Does the applicant own more than 50% of another business than the one described?*

YesNo
Does the applicant have a formal safety program in place? Note: If yes, necessary documentation will be required such as a copy of the safety program.*

YesNo
Is this a 24 hour operation?*

YesNo
Has the applicant operated without insurance coverage for 6 months or more since the business started?*

YesNo
Are there any additional interests, interested parties, mortgagees or loss payees to be added or modified with this transaction?*

YesNo
Is the business operation closed, temporarily suspended, or not expected to open within the next 30 days?*

YesNo
During the last five years (ten in RI), has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or any other arson-related crime?*

YesNo
Does the applicant have any subsidiaries, or is the applicant a subsidiary of another entity?*

YesNo
Are there any other business interests or activities of the named insured that are not identified or scheduled on this policy?*

YesNo
Have any operations been sold, acquired or discontinued in the last 5 years?*

YesNo
If needing Worker's Compensation: How many years of prior, consecutive workers' compensation coverage has the applicant had?
Please add Certificate Holder's Information (If Applicable)
Notes
Please upload current Certificate of Insurance, policy documents, insurance requirements, and any other files that will assist our team in obtaining the right coverages for you

Cancelof
Preferred Language*
Preferred Method of Contact*
Best Time of Day to Contact You*

Hour Minutes

AM/PM Option
DISCLAIMER: By submitting your information, you agree that a representative from the agency may contact you at the above-listed email or phone number. I understand that consent is not a condition of purchase and that this does not guarantee issuance of coverage.
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Commercial Insurance Quote

Business Information

Contact Information

Coverage Information

Supplementary Information