NCGINS | Commercial Quote

Commercial Insurance Quote

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General Business Information

Name of Business & Entity

Physical Business Address

Business Mailing Address

Business Phone Number

Complete Detailed Description of Your Business

Do you own the building you operate your business in?

Yes

Fire Sprinkler System

Yes

Burglar Alarm

Yes

Square footage of the space you occupy:

Deductible you would prefer:

Number of full-time employees:

Number of part time employees:

Annual payroll including and excluding owners:

Is any work sub contracted out? If so, cost of sub-contracted work per year:

Estimated annual gross sales:

Any mobile or in transit tools or equipment coverage? If so, what would it cost to replace your tools?:

Percentage of residential vs. commercial?:

Percentage of new home construction vs. other?:

Business Auto Insurance Coverage Quote Information:

Year, Make, Model, & VIN number per vehicle:

Deductible wanted for full coverage:

Driver list with date of births and license # per driver:

Workers Compensation Quote Information

Number of full-time employees:

Number of part-time employees:

Do owners want to be included or excluded on policy:

Federal ID Number (FEIN):

Breakdown of payroll per year per classification (for example office employees per year payroll, restoration employees per year payroll, Etc.):

Last 4 numbers of Social Security Numbers of all Owners:

Current Insurance Information

Business liability insurance carrier and expiration date:

Annual premium:

Any claims or losses:

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3 + 4 = ?