Commercial Quote Proposal

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Who referred you to M&A?

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Preferred contact name

First Name

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Last Name

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Best Phone number

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E-Mail Address

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Business Name

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If DBA Name

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Street Address Company is located

Street

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City

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State

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ZIP / Postal Code

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If mailing is not the same will need mailing address

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Years in business?

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Years Experienced in Industry?

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Years as a business owner?

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Ever Declared Bankruptcy?

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Currently Insured if existing company?

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If so what carrier?

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Brief Description of business operation?

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If business has staff need total number of W2 employees

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Annual Payroll amount

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If 1099 contracted staff total number

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Number of Partners/officers

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Is a buy sell agreement in place?

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Payroll for Partners/officers

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Total % of work sub-contracted

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Are Certificates of insurance required?

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Additional Insured’s Needed

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Waiver of Subrogation Needed

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IF Commercial property is needed

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Building Value

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Contents Value

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Building Construction Type

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Total Square Footage of building

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# of Stories

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Does building have a basement?

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Any updates to building?

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If so What type of update and year completed?

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Business Income needed if loss occurred?

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If so, how long?

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Does building contain Fire Extinguishers?

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Central Monitored alarm for burglar/fire?

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Does building have installed a sprinkler system?

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If Company has commercial vehicles

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Total # of vehicles

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(Will need Schedule sent separately)

Total # of drivers

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(Will need Schedule sent separately)

Radius of Operation

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Do you travel out of state?

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Any claims history in the past 3yrs?

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Please list details date/description/amount

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Submission Validation

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Enter the Validation Code from above.

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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Location

Brentwood Office
1730 General George Patton Dr
Suite 212
Brentwood, TN 37027
Local: 615.829.8457
Toll-Free: 855.207.9492

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