Florida Commercial Property Insurance Quote

Business Name:    
Premises Address:
City:
State:  (Florida)
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 
Description of Operations or SIC code:

Current Insurance Company: 
Policy Expiration Date:          (mm/dd/yyyy)

Annual Sales: $   Payroll: $
Business Income: $

Recent Insurance Information:

Other Insurance Company Used Within Past 3 Years: 
Policy #:
Losses past 3 years: Select One Yes NO     Amount paid for each loss: $
Description of losses or loss runs:


Coverage Amounts Desired:

Liability Limit Desired: Select One $500,000 $750,000 $1 million $2 million    Deductible Desired: Select One $None $1,000 $2,500 $5,000
Or choose other liability limit amount: $
Umbrella Amount Desired: Select One None $1 million $2 million $3 million $5 million

Florida Property Information:

Building 1
Building Value: $   Contents Value: $
Total Building Area:        Year Built:
Construction Type:  Select One Wood Frame Steel Reinforced Mill Concrete Block Concrete Tilt Up         Sprinklers: Select One Yes NO
Electrical Type:                             Amps:
Electrical Renovation Year: 
Plumbing Renovation: Select One None Partial Complete     Plumbing Renovation Year:
Heating Type:                 Heating Renovation Year:   
Roofing Renovation:   Select One Partial Complete     Roof Age (years):  
Central Alarm: Select One Yes NO
Distance to Florida Coastline:
Flood insurance policy in force: Select One Yes NO

List Neighboring Businesses:
To the right:   Distance:
To the left:     Distance:
To the rear:    Distance:

Additional Information or Comments


Click on the "Submit Quote Request" button below to send your
Florida Commercial Property Insurance quote request.**

**Information received from this Florida Commercial Property Insurance quote
request form sent to "YOUR AGENCY NAME" will be for our use only and will
not be sold, given to or distributed to any other parties. A quote will be based on
the Florida commercial property insurance policy information provided and
does not guarantee acceptance of the risk by us. The precise coverage
afforded is subject to meeting underwriting guidelines, and the terms, conditions
and exclusions of the policy as issued. By submitting this request you acknowledge
that this is neither an offer to insure nor a guarantee of insurance. Completion of
this form does not entitle your business to a Florida Commercial Property
Insurance policy. We are licensed in Florida and will not provide commercial
property insurance quotes for other states.

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