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Throckmorton 405-375-4144 | Martin 405-282-3770
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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.

  • General
  • Property
  • Liability
  • Auto
  • Driver Information
  • Equipment
  • Notes
E-Mail Address *
Company Name
Business Type
FEIN number
Year Business Established
First Name *
Last Name *
Social Security Number
Street *
City *
State *
ZIP / Postal Code *
Primary Phone Number *
Description of Operations
How many years of experience do you have?
Effective Date
/ /
Current Coverage
Current Insurance Provider
Prior Insurance
Claims/Property Losses in Past 5 Years (Please Explain)
General Information
Building # 1
Physical Address
Building Limit
Contents Limit
Deductible
Occupancy
Year Built
Square Footage
Construction type
Number of Stories
Roof Type
Property Updates
Distance to Fire Dept.
Building # 2
Physical Address
Building Limit
Contents Limit
Deductible
Year Built
Occupancy
Square Footage
Construction type
Number of Stories
Roof Type
Property Updates
Distance to Fire Dept.
Building # 3
Physical Address
Building Limit
Contents Limit
Deductible
Occupancy
Year Built
Square Footage
Construction type
Number of Stories
Roof Type
Property Updates
Distance to Fire Dept.
Leinholder
Leinholder
Liability Limit
Primary class code or Description
Secondary Class Code or Description
Owners Payroll
Total Payroll excluding owners
Gross Receipts
Total Number of Employees excluding Owner
Subcontractors Used
Describe work subcontracted
Additional Insureds
Waiver of Subrogation
Liability Limit
Uninsured Mortorist limit
Medical Payments
Vehicle One
Vehicle #1


Vehicle 1 VIN
Vehicle 1 - Collision Deductible
Vehicle 1 - Comprehensive Deductible
Vehicle Two
Vehicle #2


Vehicle 2 VIN
Vehicle 2 - Collision Deductible
Vehicle 2 - Comprehensive Deductible
Vehicle Three
Vehicle #3


Vehicle 3 VIN
Vehicle 3 - Collision Deductible
Vehicle 3 - Comprehensive Deductible
Vehicle Four
Vehicle #4


Vehicle 4 VIN
Vehicle 4 - Collision Deductible
Vehicle 4 - Comprehensive Deductible
Additional Vehicles and Information
Additional Vehicles or Information
Driver Information
Driver 1 Name ( first last )
Date of birth
Drivers license number
DL State
Driver 2 Name ( first last )
Date of birth
Drivers license number
DL State
Driver 3 Name ( first last )
Date of birth
Drivers license number
DL State
Driver 4 Name ( first last )
Date of birth
Drivers license number
DL State
Equipment Schedule
Item 1
Equipment Year
Equipment Make
Equipment Model
Equipment VIN #
Equipment Value $
Item 2
Equipment Year
Equipment Make
Equipment Model
Equipment VIN #
Equipment Value $
Item 3
Equipment Year
Equipment Make
Equipment Model
Equipment VIN #
Equipment Value $
Item 4
Equipment Year
Equipment Make
Equipment Model
Equipment VIN #
Equipment Value $
Item 5
Equipment Year
Equipment Make
Equipment Model
Equipment VIN #
Equipment Value $
Notes
Submission Validation
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Throckmorton Office (Kingfisher)

219 N. Main
Kingfisher, OK 73750
P: (405) 375-4144 | F: (405) 375-6516

Martin Office (Guthrie)

115 S. Broad
Guthrie, OK 73044
P: (405) 282-3770 | F: (405) 282-5240
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