Business Rate Quote - Brodbeck Porter Insurance Agency, Cincinnati, Ohio

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Business Rate Quote

Company Name

Name

Address

City, State, Zip

Day Phone

Night Phone

Email Address

About Your Business

Sole Proprietor Partnership Corporation LLC Association

Do you currently have Business Owners insurance?
Yes No

If "Yes", when does your current policy expire?

If "Yes", who are you currently insured with?

Type of Business

Description of Business Operations

Year Business Established

Years at Current Location

Do you own or lease office space?
Own Lease

Number of Locations

Number of Employees

Number of Company Vehicles

Approximate Annual Gross Revenue

Approximate Total Company Payroll

Approximate Amount of Desired Insurance

Approximate Square Footage of Occupancy

Approximate Square Footage of Entire Building

Have you been named in a lawsuit in the last year?
Yes No

If "Yes", briefly explain:

Optional coverage (check the ones you may want)

Group Health Business Property

Business Owners Malpractice

Workers Compensation Errors and Ommissions

Commercial Auto/Truck Other

Business Liability

Details

When would you like to be contacted?
Morning
Afternoon
Evening
Any Time

Any Comments / Questions?