Secured by SSL

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?
Required
Preferred contact name
First Name
Required
Last Name
Required
Best Phone number
Required
E-Mail Address
Required
Business Name
Required
If DBA Name
Optional
Street Address Company is located
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
If mailing is not the same will need mailing address
Optional
Years in business?
Required
Years Experienced in Industry?
Required
Years as a business owner?
Required
Ever Declared Bankruptcy?
Required
Currently Insured if existing company?
Optional
If so what carrier?
Optional
Brief Description of business operation?
Required
If business has staff need total number of W2 employees
Optional
Annual Payroll amount
Required
If 1099 contracted staff total number
Optional
Number of Partners/officers
Required
Is a buy sell agreement in place?
Required
Payroll for Partners/officers
Required
Total % of work sub-contracted
Required
Are Certificates of insurance required?
Required
Additional Insured’s Needed
Required
Waiver of Subrogation Needed
Required
IF Commercial property is needed
Required
Building Value
Required
Contents Value
Required
Building Construction Type
Required
Total Square Footage of building
Required
# of Stories
Required
Does building have a basement?
Required
Any updates to building?
Required
If so What type of update and year completed?
Optional
Business Income needed if loss occurred?
Required
If so, how long?
Optional
Does building contain Fire Extinguishers?
Required
Central Monitored alarm for burglar/fire?
Required
Does building have installed a sprinkler system?
Required
If Company has commercial vehicles
Optional
Total # of vehicles
Optional
(Will need Schedule sent separately)
Total # of drivers
Optional
(Will need Schedule sent separately)
Radius of Operation
Optional
Do you travel out of state?
Optional
Any claims history in the past 3yrs?
Optional
Please list details date/description/amount
Optional
Submission Validation
Required
CAPTCHA
Change the CAPTCHA codeSpeak the CAPTCHA code
 
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.
Social Social Social Social Social Social
© Copyright. All rights reserved.
Powered by Insurance Website Builder
×

Subscribe to Our Newsletter

Stay in touch with the latest events, news and offers at Montgomery and Associates.