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Commercial Business Quote


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E-Mail Address
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Company Name
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Business Type
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FEIN number
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Year Business Established
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First Name
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Last Name
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Social Security Number
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Street
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City
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State
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ZIP / Postal Code
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Primary Phone Number
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Description of Operations
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How many years of experience do you have?
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Effective Date
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/ /
Current Coverage
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Current Insurance Provider
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Prior Insurance
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Claims/Property Losses in Past 5 Years (Please Explain)
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General Information
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Building # 1
Physical Address
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Building Limit
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Contents Limit
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Deductible
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Occupancy
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Year Built
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Square Footage
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Construction type
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Number of Stories
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Roof Type
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Property Updates
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Distance to Fire Dept.
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Building # 2
Physical Address
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Building Limit
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Contents Limit
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Deductible
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Year Built
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Occupancy
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Square Footage
Optional
Construction type
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Number of Stories
Optional
Roof Type
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Property Updates
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Distance to Fire Dept.
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Building # 3
Physical Address
Optional
Building Limit
Optional
Contents Limit
Optional
Deductible
Optional
Occupancy
Optional
Year Built
Optional
Square Footage
Optional
Construction type
Optional
Number of Stories
Optional
Roof Type
Optional
Property Updates
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Distance to Fire Dept.
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Leinholder
Leinholder
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Liability Limit
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Primary class code or Description
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Secondary Class Code or Description
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Owners Payroll
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Total Payroll excluding owners
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Gross Receipts
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Total Number of Employees excluding Owner
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Subcontractors Used
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Describe work subcontracted
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Additional Insureds
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Waiver of Subrogation
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Liability Limit
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Uninsured Mortorist limit
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Medical Payments
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Vehicle One
Vehicle #1
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Vehicle 1 VIN
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Vehicle 1 - Collision Deductible
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Vehicle 1 - Comprehensive Deductible
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Vehicle Two
Vehicle #2
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Vehicle 2 VIN
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Vehicle 2 - Collision Deductible
Optional
Vehicle 2 - Comprehensive Deductible
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Vehicle Three
Vehicle #3
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Vehicle 3 VIN
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Vehicle 3 - Collision Deductible
Optional
Vehicle 3 - Comprehensive Deductible
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Vehicle Four
Vehicle #4
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Vehicle 4 VIN
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Vehicle 4 - Collision Deductible
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Vehicle 4 - Comprehensive Deductible
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Additional Vehicles and Information
Additional Vehicles or Information
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Driver Information
Driver 1 Name ( first last )
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Date of birth
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Drivers license number
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DL State
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Driver 2 Name ( first last )
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Date of birth
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Drivers license number
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DL State
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Driver 3 Name ( first last )
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Date of birth
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Drivers license number
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DL State
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Driver 4 Name ( first last )
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Date of birth
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Drivers license number
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DL State
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Equipment Schedule
Item 1
Equipment Year
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Equipment Make
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Equipment Model
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Equipment VIN #
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Equipment Value $
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Item 2
Equipment Year
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Equipment Make
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Equipment Model
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Equipment VIN #
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Equipment Value $
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Item 3
Equipment Year
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Equipment Make
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Equipment Model
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Equipment VIN #
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Equipment Value $
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Item 4
Equipment Year
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Equipment Make
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Equipment Model
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Equipment VIN #
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Equipment Value $
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Item 5
Equipment Year
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Equipment Make
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Equipment Model
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Equipment VIN #
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Equipment Value $
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Notes
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Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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  Cheap Brothers Insurance    219 N Main St  |  PO Box 297 |  Kingfisher, OK 73750  | 405-375-4145 Powered by Insurance Website Builder