J and L Insurance | Commercial Insurance Quote Form

Commercial / Business Information Form

Please fill out this form to give us the opportunity to give you the best quote for your business.

General Contact Information First Name:
Last Name:
Primary Telephone:
Mobile/Secondary Telephone:
FAX Number:
Email Address:

Business Information: Business Name:
Business Street Address:
Suite / Unit No.:
City:
State:
Zip Code:

Brief Descripton of Business:
Number of Years in Business:
Type of Business:
Number of Owners:
Number of Employees:
Gross Sales: $

Building / Structure Square Footage: ft.
Construction Type:
Year Built: xxxx
Sprinklers?
Alarm System?

Payroll Total Annual Employee Payroll: $ k
Total Annual Officer Payroll $ k
Combined Total of Annual Payroll $ K

Coverage Amount Requested

General Liability Coverage :

General Liability Coverage is avaialble for your Commerical Business or Non-Profit Organization.

Amounts are expressed with Two figures and represent dollar amounts:

Amount Per Claim - Each Occurrence / Aggregate Amount - Total Per Policy Year.

Select Coverage Amounts:

Building Coverage Amounts:

Building / Structure (Exterior) Amount Requested : $
Building Additions and Alterations (Interior): $
Coverage Amount for Building Contents: $