Commercial Business Quote
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Email *
Contact Name *
Business Name
Business Address *
Business Fax
Current Insurance Company and Policy Expiration Date *
Current Insurance Coverages *
Required
Number of full-time employees *
Number of part-time employees *
How long in business (yrs) *
How many locations? *
Please give a brief description of your business and clientele. *
Business Address Occupancy Status *
Year Built *
% Occupied
Sprinklers
Construction Type
Stories
# of Basements
Sq. Footage
Burglar Alarm
Building Value
Contents
Other Property (specify)
Limits requested
Describe any claims you've had in the past 5 years *
Additional Comments
Disclaimer Notice: The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.                                                                   ©2019 All Rights Reserved Farris Insurance Agency  PO Box 909 Valdese, NC 28690 (828)874-3250     *
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