Help us
STOP Nationalized
Health Care!!

Click here to request information on the nations health care crisis !!
Subscribe for our NEWSLETTER !!

 

Commercial General Liability Request A Quote

InsuranceMakesMeSick P&C Agency represents many insurance companies; each with specific information that they require to get a quote. Because there is so much information that we need, please fill out this form to get us started, and we will contact you to discuss your insurance needs and get more information.

COMPANY INFORMATION* (required)
Contact first name* (required)
Contact last name* (required)
Company name* (required)
Business Entity
Federal Tax ID Number or SSN if sole prop
Street address
Apartment / Suite number
City
Zip code
County
Work phone number with area code* * ext
Home phone number with area code
Email address
Nature of business

Year Business Started

Years Management experience
Currently insured with
Policy number
Expiration date
Current annual premium
.
Of the following sections, the General Liability (GL) MUST be completed. If you have company vehicles you would like
to insure, please complete the commercial auto section.
Remember to complete the property information if you own or rent a property you would like to cover.
GENERAL LIABILITY (GL)
Limits of liability
Number of owners
Number of employees
Employee annual payroll
Do you use subcontractors
Subcontractors annual payroll
Gross sales
Office square feet
COMMERCIAL AUTO
Do you have
any company vehicles?		  Yes No
COMMERCIAL
PROPERTY
Property
address (if different form above)
City, State and Zip (if
different form above)

County (if
different form above)
Year built
Property construction
Property roof
Wire type
Property square feet
# of Stories
Monitored alarm  Yes No

»IMPORTANT
 Yes No
I understand insurancemakesmesick.com will attempt to find me the lowest rate with companies we represent. These companies may run underwriting reports in order to provide an accurate quote. By checking this box, you authorize us or the insurance companies to run consumer reports including, but not limited to C.L.U.E., MVR, UDD and credit.

Please read the disclaimer and verify that all the information you have entered is correct. Then click on the Submit button to send us your quote

Thank you for using our site. Please feel free to complete our online quote form. You will be contacted by one our insurance professionals to discuss your quote.

If at any time you have a question call (972) 463-3833 for personal service.

2621 Elm Grove Road .Wylie, Texas 75098

Phone: (972) 463-3833