For a
Business
insurance quote simply fill out the form below and click the submit button. One of our agents will contact you to review a personalized quote within 24 hours. If you have any questions regarding this form or regarding coverage in general, please feel free to
contact us
.
Personal Info
First Name:
Last Name:
Business Name :
Address :
City:
State:
Zip Code:
E-mail:
Telephone:
Fax:
Best time to call:
Business Information
Your curent Insurance Company?:
Expiration Date?:
What type of coverages do you currently have:
Bond
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers
Liability
Disability
Group Health
Group Life
Professional
Liability
Workers'
Compensation
Other
About Your Business
Type of business:
Please select:
Office
Service
Retail
Wholesale
Habitational
Other:
# of Full-time Employees
# of Part-time Employees
How Long in Business
How Many Locations
Annual Payroll
Approximate
Annual sales:
Please provide a brief description of your business and clientele:
Coverage Information
Coverages:
Bond
Commercial Auto
Commercial
Liability
Commercial
Property
Commercial Umbrella
Directors & Officers
Liability
Disability
Group Health
Group Life
Professional Liability
Workers'
Compensation
Other
Comments and additional pertinent information:
Submitting an insurance quotation request to Durkin & DeVries Insurance does not constitute a binding confirmation of new or altered insurance coverage. Verbal or written confirmation must be obtained from Durkin & DeVries Insurance to confirm binding or altering coverage.
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