Marion Miller Insurance

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Business Insurance Services

Personal Insurance Services

 

Business Owners Insurance Quote

One simple form takes only a few minutes.

YOUR PERSONAL DATA:

Your Name:  
Property Address:  
City:  
State::  
Zip/Postal:  
*E-Mail  
Re enter your E-Mail  
Phone:  
Fax (optional):  
     
Currently Insured?
(If yes, list carrier, and # of years continuous. If none, type NONE)
 
Type of Business:  
Office
Other
   
List Claims & Amounts Paid:
(If none, type NONE)
 
Years In Business:  
Business type:
(proprietorship, corporation, etc.)
 
Describe Business in detail:
(i.e., Delicatessen and sandwich shop, etc.)
 
     

Underwriting Information:

Describe IN DETAil,
Your Business Operations:
 
 

Ownership & Payroll Data:

List Employee's Annual
Payroll Here (if none,enter $0):
 
Insert # of
Employees here:
 
 

Location & Sales Information:

Insert Annual GrossRevenues from this operation here:  
Square Footage of office or business operation here: 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):  


Year Built:  
Flood ZONE NUMBER:
(look on current policy, if any)
 
Flood COMMUNITY NUMBER:
(look on current policy, if any.)
 

Coverage Desired: (Check One Please)

The Coverage I Am Looking For:

 

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.)
 
Liability Coverage:
($300,000, $500,000, $1 Million, etc.)
 
 
Business Contents Coverage:
(The amount of your personal business property)
 
 
Building Coverage:
(The amount of building coverage if you own your bldg.)
 
 
Miscellaneous Coverage:
(List any special coverage peculiar to your . business, such as Garagekeepers legal, loss of Earnings, Valuable Papers, etc.)
 

Send my quotation via:

 

 
Fax
Please Call by Phone
 

Thank you for filling out this form COMPLETELYI

We value your input as PRIVATE information. Every step has been taken to assure 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 Businessownership Quote Please.

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