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General Liability Quote Form
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GENERAL LIABILITY

  • LOW RATES!
  • FAST QUOTES!
  • PROMPT CERTICATES!

    WE WILL RATE AS MANY AS 42 QUALITY CARRIERS TO GET YOU THE BEST QUOTE! EASY PAYMENT PLANS. HERE ARE SOME OF THE RECENT ACCOUNTS WE HAVE PLACED:

    • Your Name:
    BUSINESS Name:
    Mailing Address:
    City:
    State:
    Zip/Postal:
    E-Mail (REQUIRED):
    E-Mail again for accuracy:
    Phone:
    Fax (optional):
     
    Business Underwriting Information
    Type of operation:
    Describe operations in detail:
    License class:
    License Number:
     
    Limit of Liability
    Coverage Requested?    		 $300,000
    $500,000
    $1 Million
     
    Currently Insured? Yes No
    Name of Carrier & how long insured?
    Prior Claims? Yes No
    Describe claims in detail:
     
    Years in business:
    Years experience in field:
    Percentage of work residential:
    Percentage of work commercial:
     
    Number of Active Owners:
    Number of Employees: 0   1   2   3+
    Annual Employee Payroll: $
    Annual Gross Sales: $
     
    Do you subcontract work? Yes No
    (If yes, what percentage of your work
    is subbed, and what kind of work?)
    Do you do foundation work? Yes No
    Do you use hot tar? Yes No
    Any Claims in last 3 years? Yes No
    Do you work on condos, apartments or Townhomes? Yes No
    Do you have a safety program? Yes No

     
    Comments/Remarks:
     
    Send my quotation via: E-Mail Fax
    Regular Mail
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    Thank you for filling out this form COMPLETELY!

    We value your input as PRIVATE information. Every step has been taken to insure 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 them 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 Quote NOW!

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    Business 1st Insurance Agency . 3684 Tampa Road Suite 6 . Oldsmar, FL 34677
    Toll Free Phone: 1-800-253-7040 . Local Phone: 813-448-9222 . Fax: 813-448-9244 . Toll Free Fax: 800-307-5160
    Our Telephone Quote Hours are: 9:00-5:00 (Monday-Friday) | Our Privacy Notice
    E-Mail us at: vickie@business1stinsurance.com | © 2008,
    Business 1st Insurance Agency.
    California License #0E61983 . Texas License #1416119 . Arizona License number #873215
    Colorado License #277626 . Louisiana License #417236 . Nevada License number #634600
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