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Commercial Quote Application
infomixa
2024-06-12T14:02:26+00:00
Commercial Quote Application
Quote Type
(Required)
Please Select
Artisan Contractor
Habitational
Name
(Required)
First
Last
Phone
(Required)
Email
Name of Business
Physical Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Years In Business
When was it purchased?
Years Managing Business
Total Annual Revenue
Total Annual Gross Rent Revenue
# of Full Time Employees
# of Part Time Employees
Any 1099 Employees/Contractors?
Employee Payroll
How Many Buildings?
How Many Units?
How Many Stories?
Are there Smoke Detectors & Fire Alarms in each unit & Hallway?
Security Systems?
Fire Sprinklers?
Any Mailboxes?
Any pools, hot tubs, or carports? (SqFT of each)
Who are you currently insured with?
Any claims in the past 5 years?
[For an older building] When the roof last replaced? HVAC, Plumbing and Electrical
How much would it cost to replaced the appliances in each unit?
EIN
Total Claims
What Happened
Business Description (Daily Operations)
% Of Residential Work
% Of Commercial Work
Equipment & Tools (Itemize > $2k)
Do They Own Or Lease This Building
Current Carrier
Vehicles Insured & VINs
Drivers (Name, DOB, DL)
Additional Notes
Submitted By
(Required)
Please Select
Aron G
Ashley E
Brad C
Carson H
Chad F
Christine C
Cody C
Corey J
Fred W
Jacob Me
Jessika R
John S
Jose C
Julie S
Kendall E
Kimberly K
Kyle W
Kylie W
Lindsey R
Mackenzie C
Matthew E
Michael M
Natalie J
Rachel S
Ron L
Samantha S
Stephen M
Stephen Mo
Tiffany L
Vlad C
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