Commercial Real Estate Quote This field is hidden when viewing the formSalespersonLegal Entity NameDBABusiness Entity Type(Required)Select OneLLCPartnershipIndividualCorporationJoint VentureAssociationProperty ManagerOtherFederal Tax Identification NumberMailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Role(Required)AccountantBusiness OwnerBusiness PartnerCompany ExecutiveExecutiveLLC MemberOffice ManagerOtherPrimary Contact Name(Required) First Last Primary Phone(Required)Primary Email(Required) Year Business Established Or Acquired By Current OwnerYears Of Management Experience In This IndustyCurrent owner has maintained continuous insurance for business: Yes No Does The Applicant Own, Or Lease On A Long Term Basis, Any Business Autos Yes No Does The Applicant Want To Quote Scheduled Business Auto Yes No Insured Buildings Building Number Location Address Actions Edit Delete There are no Buildings. Add Building Maximum number of buildings reached. Each Building for each Location must be entered.To expedite your Proposal, we need the following for all risks:Loss History for the Past Five Years Drop files here or Select files Max. file size: 128 MB. We need this to provide discounts, and for Underwriting approval. Claims History – aka “loss runs” are ordered by you from your current Agent and/or Insurance Company. It is a good business practice to order these yearly. Loss History is only provided to Owner / Property Manager, we do not have access or authority to request.This field is hidden when viewing the formLoss History for the Past Five YearsMax. file size: 128 MB.We need this to provide discounts, and for Underwriting approval. Claims History – aka “loss runs” are ordered by you from your current Agent and/or Insurance Company. It is a good business practice to order these yearly. Loss History is only provided to Owner / Property Manager, we do not have access or authority to request.This field is hidden when viewing the formCopies of your Property Liability and Umbrella Coverages, if any. Drop files here or Select files Max. file size: 128 MB. This field is hidden when viewing the formCopies of your Property Liability and Umbrella Coverages, if any.Max. file size: 128 MB.Consent(Required) I Agree to the Privacy Policy, Terms of Service, and to Receive Communications.PhoneThis field is for validation purposes and should be left unchanged. Δ
