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Business Insurance Quote

Insurance coverage for businesses of all sizes.

Business Insurance Quote Request

Home » Business Insurance Quote

Complete our form and we’ll get back to you with your business insurance quote.

Commercial Intake Data Form

Thank you for allowing The Insurance Advisor the opportunity to provide you with business insurance quote(s). Before we get started, we need to know about you and your business. The information you provide is essential for us to conduct a thorough risk analysis.

Once we’ve identified the business exposures, we will then select the appropriate Commercial and Liability Insurance carriers. Our Licensed Agents will shop your business insurance with these carriers to identify the best fit for your insurance needs, at an affordable price.

Please complete any portion of the form that pertains to your business. If a question does not apply, please notate using “n/a.”

Applying for Commercial Insurance can be a lengthy process, but we will shop and secure your insurance as quickly as possible. The underwriters may require supporting documents indicated on the application. There is no guaranteed timeline in which we will find the correct fit for your insurance needs.

Name of Insured
Full Name of Insured
Insured Date of Birth
Month
Day
Year
Insured Driver's License Number
Insured Driver's License Number
SSN/FEIN Number
SSN/FEIN Number
Legal Company Name
Legal Company Name
DBA
DBA
Type of Entity (Select All That Apply)
- Sole Proprietor
- Incorporated
- Nonprofit
- Partnership
- Limited Liability Company
- Trust
Year Business Began
Month
Day
Year
Years of Experience in Same Industry
Years of Experience in Same Industry

Name of All Owners and Percent of Ownership

Full Name	Percent of Ownership
Full Name	Percent of Ownership

Business Address
Street Address Address Line 2 City State/Prov./Region ZIP/Postal Country
Business Phone
Business Phone
Mobile Phone
Mobile Phone
Fax Number
Fax Number
Email
Email
Description of Business Operations
Description of Business Operations
Description of Business Operations, Products/Services. Please be as specific as possible.
Type of Insurance Required, If Known (Select All That Apply)
- General Liability
- Business Property
- Professional Liability
- Building Coverage
- Errors & Omissions
- Liquor Liability
- Employee Practice Liability
- Workers Comp
- Employee Benefits Coverage
- Cyber Liability
- Commercial Auto
- Umbrella
- I'm Not Sure What Type of Insurance I Need
Amount of Liability Required, If Known
- $1 mil/$2 mil General Liability
- $2 mil/$4 mil General Liability
- $500,000 CSL (Commercial Auto)
- $1,000,000 CSL (Commercial Auto)
- 100/100/500 Work Comp
- 500/500/500 Work Comp
- $1 Mil umbrella
- Greater than $1 Mil umbrella
- I need coverage not included in these options

Claim Information

If your company has had any claims, please list the claim, approximate dates, and amounts paid (if known). This information will be verified at a later time.

Claim	Date(s)	Amount
Claim	Date(s)	Amount

Additional Insureds

Additional Insureds (Lien holder, Mortgage Company, Leasing Company/Landlord, etc. Please include company name, complete mailing address, contact person/department and account/loan numbers)

Company Name	Mailing Address	Contact Person	Account/Loan Numbers
Company Name	Mailing Address	Contact Person	Account/Loan Numbers

Number of Employees (Full Time and Part Time)
Number of Employees (Full Time and Part Time)
Annual Payroll in $ (include 1099 payroll but indicate separately)
Annual Payroll in $ (include 1099 payroll but indicate separately)
Annual Gross Revenue
Annual Gross Revenue
Value of Business Property (If Any)
Value of Business Property (If Any)

Company Vehicles

Number of Company Vehicles and Types (if Commercial Auto is Desired)

Number	Type
Number	Type

Licensed Drivers

Licensed Drivers (Name, Birth Date, Drivers License Number, & Marital Status)

Full Name	Birth Date	Drivers License Number	Marital Status
Full Name	Birth Date	Drivers License Number	Marital Status

Additional Information
Additional Information
Any Other Information You Feel May Be Helpful in Providing a Quote
This field is for validation purposes and should be left unchanged.
This field is for validation purposes and should be left unchanged.

Business Insurance Quote - Close-up Portrait of a Business Man Using a Tablet in the Office

How It Works

It only takes a minute to get started.

Fill out the form for a business insurance quote, and we'll be in touch.
Go over your options with an agent.
Get the coverage you need.

Would you rather discuss this in person? Get in touch with an agent today!

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We are here to advise you on your insurance.

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