Home
Products
Contact
1
Business Info
2
Property Details
3
Coverage Options
4
Risk Assessment
5
Contact Info
6
Review
Business Information
Tell us about your business
Business Legal Name *
DBA (Doing Business As)
Business Entity Type *
Select Type
Sole Proprietorship
Partnership
LLC
Corporation
S-Corporation
Non-Profit
Industry Type *
Select Industry
Retail Store
Office/Professional
Restaurant/Food Service
Manufacturing
Warehouse/Distribution
Medical/Healthcare
Technology/IT
Construction
Automotive
Hotel/Hospitality
Education
Gym/Fitness
Other
Year Established *
Federal Tax ID (EIN)
Business License Number
Number of Employees *
Select Range
Just Me
2-5
6-10
11-25
26-50
51-100
101-250
250+
Annual Revenue *
Select Range
Under $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1 Million
$1M - $2.5M
$2.5M - $5M
$5M - $10M
Over $10M
Number of Locations *
Select
1
2
3
4
5
6-10
More than 10
Brief Business Description *
Primary Property Location
Property Address *
City *
State *
Select State
Ohio
Pennsylvania
Michigan
Indiana
West Virginia
Kentucky
ZIP Code *
Property Occupancy *
Select Type
Owner Occupied
Tenant/Lease
Currently Vacant
Partially Occupied
Building Type *
Select Type
Office Building
Retail Space
Warehouse
Industrial
Mixed Use
Strip Mall
Standalone Building
Medical Building
Restaurant
Year Built *
Total Square Footage *
Number of Stories *
Select
1
2
3
4
5-10
More than 10
Construction Type *
Select Type
Frame
Joisted Masonry
Non-Combustible
Masonry Non-Combustible
Fire Resistive
Roof Type *
Select Type
Flat/Built-up
Metal
Shingle
Tile
Slate
Rubber Membrane
Roof Age (Years) *
Last Major Renovation
Fire Sprinkler System *
Select
Full Building Coverage
Partial Coverage
No Sprinkler System
Security/Alarm System *
Select
Monitored 24/7
Local Alarm Only
No Alarm System
Estimated Building Value *
Business Personal Property Value *
Equipment, inventory, furniture, etc.
Coverage Options
Select desired coverages:
Building Coverage
Business Personal Property
Business Income/Interruption
Extra Expense Coverage
Ordinance or Law
Outdoor Signs
Glass Breakage
Equipment Breakdown
Preferred Deductible *
Select Amount
$500
$1,000
$2,500
$5,000
$10,000
$25,000
Coinsurance Percentage *
Select
80%
90%
100%
Risk Assessment
Have you had any property insurance claims in the past 5 years? *
No
Yes
Is the property in a flood zone? *
No
Yes
Not Sure
Additional Information
Contact Information
Contact Name *
Title/Position *
Email Address *
Phone Number *
Best Time to Contact
Any Time
Morning (8AM-12PM)
Afternoon (12PM-5PM)
Evening (5PM-8PM)
Preferred Contact Method
Either Phone or Email
Phone
Email
Back
Submit Quote Request