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

Required

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

Required

Primary Phone Number

Required

Description of Operations

Optional

How many years of experience do you have?

Optional

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
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 Optional
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 Optional
Equipment VIN # Optional
Equipment Value $ Optional
Item 2
Equipment Year Optional
Equipment Make Optional
Equipment Model Optional
Equipment VIN # Optional
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 Optional
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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 \| 405-375-4144		Powered by Insurance Website Builder