Commercial Quote
Please answer all of these questions and then we'll be able to get you a quote for your business.  Thank you very much!
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Business Name *
Phone Number
Best email address for us to contact you
Legal Entity *
How did you hear about us?
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Main Business Address *
Business Website address
Year Business Started *
Federal Employer Identification Number (or SS# if no FEIN) *
Name and DOB of all owners *
Years experience in this field *
Description of work performed/Description of business.   If manufacturing, describe/list what parts/products are made and for what industry. *
Current Insurance Carrier (enter 'none' if new) *
Current Policy expiration date (may leave blank if new)
Length of time with current carrier (approx # of years)
Describe any losses in past 3 years.  Enter N/A if none *
Gross Annual Income *
Number of Employees *
Annual Payroll to employees (if applicable) *
Annual payroll for all owner's combined
Desired Liability Limit *
Business Personal Property coverage amounts and description of what needs insurance
Year built
Square footage owned/occupied
Other comments, notes, etc?
Building owned or leased *
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This form was created inside of Shield Insurance Agency.