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Commercial General Insurance Quote

Please fill in all information accurately.

Commercial General Form
Name of Business
Address

City

State

Zip
Phone

Fax

Contact Name

Email address

Type of business

No. of employees
Years in Business

Years experience

Building size (sq. ft.)
Annual Payroll

Gross receipts

Prior Insurance Company

Any losses?

Yes

No
Amount of Coverage
Any Subcontractor?

Yes

No
Sub Payroll?
Yes
No

Subs carry own coverage or waiver signed?

Limits of coverage/waiver
Loss Runs Past 3 Years?
Statement of No Loss (if new venture or no prior)
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