List Employee's
Annual Payroll Here (if none, enter $0):
$
Insert #
of Employees here:
Location & Sales
Information:
Insert Annual
Gross Revenues from this operation here:
$
Square Footage
of office or business location:
Type of Building
(wood frame, concrete, etc.):
Number of
Stories:
Are there other
business/residences in this building (describe)?:
Describe safety
features (alarm, sprinklers, fire protection, etc):
Provide breakdown percentages of work
provided: Passenger % Truck %
Off-the-Road %
Coverage Desired:
(Check One Please)
Policy Type I am Interested In: Claims
Made Form Occurrence Form
Limits of
Liability Coverage I am Interested In: $250,000 $500,000 $1
Million $5 Million
Limit of business property needed: $
Limit of Garagekeepers Coverage Needed: (Total amount of vehicle(s) left in your
possession.) $
NOTE: Don't worry if
you are not exactly sure about coverage type... we will
suggest the best coverage for you - just try to tell us what
you are looking for! (If we need more info. we will let you
know.)
Send my
quotation via:
E-Mail Fax Regular
Mail Please
Call by Phone!
Thank you for filling out this
form COMPLETELY!
We value your input as PRIVATE information.
Every step has been taken to insure your privacy, security,
and our intent is to release quote information only to you. We
will not give your data to ANY other person or group for
sales, marketing, or ANY other purposes. By checking the box
below you agree to allow our agency to release this
information via the method you have chosen, and to release us
from any liability should this information be accidentally
viewed by others. Our intention is to maintain your complete
privacy.
Yes, I Agree.
Please Send Me a Garage/Auto Repair Shop Insurance Quote
NOW!
Click Button
Below When Done
Please
Click Only Once . . . May take up to 30 seconds!
