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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
Required
Business Name
Required
If DBA Name
Optional
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?
Optional
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
Optional
Number of Partners/officers
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Is a buy sell agreement in place?
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Payroll for Partners/officers
Required
Total % of work sub-contracted
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Are Certificates of insurance required?
Required
Additional Insured’s Needed
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Waiver of Subrogation Needed
Required
IF Commercial property is needed
Required
Building Value
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Contents Value
Required
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?
Required
Any updates to building?
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If so What type of update and year completed?
Optional
Business Income needed if loss occurred?
Required
If so, how long?
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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
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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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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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