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Business Quote
Please complete the form below and we will contact you with a customized quote from Konell Insurance.
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Email
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Your email
Name:
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Your answer
Address:
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Your answer
City:
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Your answer
State:
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Your answer
Zip
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Your answer
Phone:
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Your answer
Work Phone:
Your answer
Business / Coverage Information
Please describe the nature of your business and desired coverage.
Business Name:
Your answer
Description of Business:
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Type of Policy Desired:
Liability Only
Workers Comp.
Commercial Auto
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Number of Employees:
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Current Carrier:
Your answer
Expiration Date:
MM
/
DD
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YYYY
Any claims in the past 5 years?
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How long in this business?
Your answer
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