Commercial Insurance
        Initial quote form for commercial insurance      

Section I - General Information

         Local Business Name:
                     Contact Person:    
                    Mailing Address:
                                                    
                   Business Phone:         Fax #:     
Federal Tax Identification #:
                  Type of Business:
                                               

Section II - Property Information

                            Property Address:
               Construction of Building:
                                 Age of Building:
Square footage of Your Premises:
                    Occupancy of Building:
       Number of Stories of Building:
     Sprinkler System w/in Building: Yes No

Estimated Property Values                Deductible
 
  Building: $          $250  $500  $1,000
 Contents: $          $250  $500  $1,000
 Inventory: $         $250  $500  $1,000
        Sign: $         $250  $500  $1,000
Computer: $         $250  $500  $1,000

Section III - General Liability Information

   Description of your business:  
            Estimated Annual Sales:  $
          Estimated Annual Payroll: $
Select Desired Limit of Liability: $300,000     $500,000       $1,000,000
             Umbrella Liability Limits: $1,000,000  $3,000,000    $5,000,000

Section IV - Business Auto Information

                          Liability Limit: $300,000    $500,000    $1,000,000
                 Medical Payments: $1,000        $2,000         $5,000
               Uninsured Motorist: $300,000   $500,000     $1,000,000
Comprehensive Deductible: $100          $250             $500
             Collision Deductible: $250          $500              $1,000

Driver List
          
       Full Name                         Date of Birth                      Drivers License #

Vehicle List

Section V- Workers Compensation Information

Back to Iori Insurance Home Page

Back to Services Page