| Commercial
Quote |
| The following fields must be filled out completely and
accurately in order to obtain a quote. |
|
|
| Name of
contact person: |
Required |
| Name of
business: |
Required |
| Select
one: |
Required |
| Number
of locations: |
|
Any outside AB? |
Yes
No |
| Street: |
|
| City: |
|
| Province: |
|
| Postal Code |
|
| Phone # (Include Area Code): |
Required |
| Fax # (Include Area Code) |
|
| E-mail: |
Required |
| How
would you like to be contacted? |
Required |
| Type of
business operation: |
Required |
| Number
of years in business: |
Required |
| Current
insurance carrier: |
|
| Exp.
date of current insurance policies: |
|
| Have you
had any losses or claims, regardless of fault, in the past three
years? |
Yes
No |
| Number
of vehicles: |
Required |
| Number
of employees: |
Required |
| Estimated
annual gross receipts: |
Required |
| Estimated
annual payroll: |
Required |
Total
estimated property value:
(buildings, contents, equipment, etc.) |
Required |
| Select
the coverage(s) you are interested in: |
Commercial
Property |
Umbrella
Liability |
|
General
Liability |
Employee
Benefits |
|
Workers
Compensation |
Contractors
Equipment |
|
Other |
| Instructions |
 |
To help against unsolicited email we ask that you enter this code below in the "Validation Code" field. |
|
| *Validation Code |
Required
|
