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You may get a premium quotation on line for all your Personal and Business insurance needs, such as: Auto, Homeowners, Renters, Condo Units, Individual Health, Group Health, Short Term Health, International Health, and Life Insurance - Businessowners Insurance, General Liability Insurance Workers Compensation Insurance for Offices, Retail and Wholesale Stores, Service Businesses, Manufacturers, Contractors and much more.

All Personal and Commercial Insurance Programs can be custom tailored to fit your individual and business specific needs.

General Liability Quote

For a quick and competitive quote for your Business General Liability Insurance, please, complete the following information. Please be as specific as possible.
Primary location must be in the states of Illinois, Wisconsin and Nevada.
General Information
Business name: *  
Contact name: *  
Address: *  
City:*  
State: *  
Zip code: *  
County: *  
Phone: *  
Fax:    
E-mail address:*  
Business Information
Year business started: *  
How many years of experience does the business owner have in your industry: *  
# of business vehicles: (If applicable)  
Business legal entity: *  
Type of business: :  *  

Detailed nature of your business: *

 
Number of active owners and/or partners: *  
Number of  full-time employees: *  

 Number of  part-time employees: *

 
Do you use sub-contractors?: *  
If yes, What is the annual cost  *   $ 
Active owners and/or partners estimated annual payroll: *   $
Employees estimated annual payroll: *   $
Business gross annual sales: *   $
Current Insurance Coverage Information

 Are you currently insured?  *

   

If yes, what company (Not Agency) 

 

Expiration date of in-force policy: 

  (mm/dd/yy)
Please explain all claims, including dates and amounts paid in the past three (3) years (Write NONE if no claims) *   

 Expiring policy annual premium:

 
Renewal policy annual premium:   (If available)
Building Information

Do you own or lease your office space: *

 

Building occupancy *

 

Address *

 

City *

 

State *

    Primary location must be in the state of Illinois.

Zip Code *

 

Country *

 
Total square footage of your building: *   Enter N/A if not applicable
Total square footage of your space: *   Enter N/A if not applicable
Coverage Desired
Approximate amount of liability 
coverage desired: *
Other coverage desired?: (Please Describe)
Effective date of coverage *   (mm/dd/yy)
Additional information:  
Other coverages you are interested in
Employment Practices Liability
Crime
Directors and Officers Liability
Professional Liability
Workers Compensation
  Key Man Life 
Key Man Disability

401K/Retirement

Group Health

Group Life
Group Disability 

Other:

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