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(615) 220-9890
HOME
ABOUT
CLIENT SERVICES
REQUEST A QUOTE
RESOURCES
CONTACT
Business Quote
Step
1
of
7
- Applicant
14%
Name
*
First
Middle
Last
Date of Birth
Month
Day
Year
Email
*
Phone
*
Fax
Business Name
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
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Virgin Islands, U.S.
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Country
How is Business Structured
Individual
Partnership
Corporation
Subchapter "S" Corporation
Limited Corporation
Other
How Did You Find Us?
Search Engine
Office/Road Sign
Referral
Advertisement
Phone Book
Direct Mail Item
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Company Name
Policy Expiration Date
Month
Day
Year
Coverages
*
Bond
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors and Officers Liablity
Disability
Group Health
Disability
Group Life
Professional Liablity
Workers' Compensation
Other
If Other Please Specify
Number of Full-Time Employees
*
Number of Part-Time Employees
*
How Many Years Have You Been in Business?
*
How Many Locations?
*
Please give a detailed description of your business and clientele
*
Occupancy Status
Owner
Tenant
Year Built
% Occupied
Sprinklers
Yes
No
Construction Type
Frame
Brick Veneer
Stucco
Metal
Concrete
Stories
Number of Basements
Square Footage
Burglar Alarm
Yes
No
Building Value
Contents
Other Property (Specify)
Please describe updates to property if over 20 years old.
Annual Gross Sales: (Before Taxes)
Annualized Payroll
Cost of any Subcontracted Work
Limits Requested
$300,000
$500,000
$1,000,000
$2,000,000
Describe any claims you've had in the past 5 years
Comments/Additional Information
Captcha
E-Mail: service@barrettagency.org
Office Hours: Monday - Friday, 8 a.m.- 5 p.m.
Telephone: (615) 220-9890
Fax: (615) 220-9838