Business Quotes

Business Insurance Quote

To obtain a quote for your business, please complete the form below. We will shop your policy with the best insurance providers and will contact you within one business day to review your comparative quotes.

Owner's Name *
Contact Phone Number *
Fax Number
Website Address (URL)
Contact Email Address
Name of Business
Organization
Business Address
Type of Work
Years in Business *
Years Experience in Industry
Experience in field (please describe - provide resumes if possible)
General Liability (Desired Coverage)
Current General Liability Expiration Date
E & O Professional Liability (Desired Coverage)
Current E & O Professional Liability Expiration Date
Worker's Compensation (Desired Coverage)
Current Worker's Compensation Expiration Date
Business Auto (Desired Coverage)
Current Business Auto Expiration Date
Bond (Desired Coverage)
Current Bond Expiration Date
My Current Insurance Status
Current Auto Insurance Status
Vehicle 1 Year
Vehicle 1 Make
Vehicle 1 Model
Vehicle 1 VIN Number
Vehicle 1 Coverage Requested
Vehicle 1 Driver's Name (as on license)
Vehicle 1 Driver's Date of Birth
Vehicle 1 Driver's WDL#
Vehicle 1 Driver's Tickets/Accidents in Last 3 Yrs
Vehicle 2 Year
Vehicle 2 Make
Vehicle 2 Model
Vehicle 2 VIN Number
Vehicle 2 Coverage Requested
Vehicle 2 Driver's Name (as on license)
Vehicle 2 Driver's Date of Birth
Vehicle 2 Driver's WDL#
Vehicle 2 Driver's Tickets/Accidents in Last 3 Yrs
I have more than 2 vehicles to insure.
Business Property
Roof (Year Updated)
Furnace (Year Updated)
Plumbing (Year Updated)
Wiring (Year Updated)
Year Built
Construction Material
Square Feet
Number of Stories
Previous Claims
Previous Claims (Please describe in detail)
Annual Revenue (Last Year)
Annual Revenue (Upcoming Year)
Number of Employees
Number of Active Owners
Projected payroll for next 12 months (not including owners)
Comments

ROBINSON-MAURER-WELTS

Insurance Brokers & Consultants ~ Seattle