Commercial Business Quote

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

E-Mail Address

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Company Name

Optional

Business Type

Optional

FEIN number

Optional

Year Business Established

Optional

First Name

Required

Last Name

Required

Social Security Number

Optional

Street

Required

City

Required

State

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ZIP / Postal Code

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Primary Phone Number

Required

Description of Operations

Optional

How many years of experience do you have?

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Effective Date

Optional

Current Coverage

Optional

Current Insurance Provider

Optional

Prior Insurance

Optional

Claims/Property Losses in Past 5 Years (Please Explain)

Optional

General Information

Optional

Building # 1

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

Optional

Distance to Fire Dept.

Optional

Building # 2

Physical Address

Optional

Building Limit

Optional

Contents Limit

Optional

Deductible

Optional

Year Built

Optional

Occupancy

Optional

Square Footage

Optional

Construction type

Optional

Number of Stories

Optional

Roof Type

Optional

Property Updates

Optional

Distance to Fire Dept.

Optional

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

Optional

Distance to Fire Dept.

Optional

Leinholder

Optional

Liability Limit

Optional

Primary class code or Description

Optional

Secondary Class Code or Description

Optional

Owners Payroll

Optional

Total Payroll excluding owners

Optional

Gross Receipts

Optional

Total Number of Employees excluding Owner

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Subcontractors Used

Optional

Describe work subcontracted

Optional

Additional Insureds

Optional

Waiver of Subrogation

Optional

Liability Limit

Optional

Uninsured Mortorist limit

Optional

Medical Payments

Optional

Vehicle One

Vehicle #1

Optional

Vehicle 1 VIN

Optional

Vehicle 1 - Collision Deductible

Optional

Vehicle 1 - Comprehensive Deductible

Optional

Vehicle Two

Vehicle #2

Optional

Vehicle 2 VIN

Optional

Vehicle 2 - Collision Deductible

Optional

Vehicle 2 - Comprehensive Deductible

Optional

Vehicle Three

Vehicle #3

Optional

Vehicle 3 VIN

Optional

Vehicle 3 - Collision Deductible

Optional

Vehicle 3 - Comprehensive Deductible

Optional

Vehicle Four

Vehicle #4

Optional

Vehicle 4 VIN

Optional

Vehicle 4 - Collision Deductible

Optional

Vehicle 4 - Comprehensive Deductible

Optional

Additional Vehicles and Information

Additional Vehicles or Information

Optional

Driver Information

Driver 1 Name ( first last )

Optional

Date of birth

Optional

Drivers license number

Optional

DL State

Optional

Driver 2 Name ( first last )

Optional

Date of birth

Optional

Drivers license number

Optional

DL State

Optional

Driver 3 Name ( first last )

Optional

Date of birth

Optional

Drivers license number

Optional

DL State

Optional

Driver 4 Name ( first last )

Optional

Date of birth

Optional

Drivers license number

Optional

DL State

Optional

Equipment Schedule

Item 1

Equipment Year

Optional

Equipment Make

Optional

Equipment Model

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Equipment VIN #

Optional

Equipment Value $

Optional

Item 2

Equipment Year

Optional

Equipment Make

Optional

Equipment Model

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Equipment VIN #

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Equipment Value $

Optional

Item 3

Equipment Year

Optional

Equipment Make

Optional

Equipment Model

Optional

Equipment VIN #

Optional

Equipment Value $

Optional

Item 4

Equipment Year

Optional

Equipment Make

Optional

Equipment Model

Optional

Equipment VIN #

Optional

Equipment Value $

Optional

Item 5

Equipment Year

Optional

Equipment Make

Optional

Equipment Model

Optional

Equipment VIN #

Optional

Equipment Value $

Optional

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.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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Cheap Brothers Insurance 219 N Main St \| PO Box 297 \| Kingfisher, OK 73750 \| 405-375-4144		Powered by Insurance Website Builder