[Link1] | [Link2] | [Link3]

Home
About Us
Our Process
Individuals
Businesses
Professionals
Quick Quote
Our Blog
Contact Us

Louisville insurance Schwartz Insurance Group review your coverage, Insurance coverage

Call Us

(502) 451-1111

(800) 366-8117

Visit Us

2950 Breckenridge Lane

Louisville, KY 40220

View Larger Map

Business Quote

General Information

First Name: *

Last Name: *

Email: *

Business Name:

Address:

City:

State:

Zip:

County:

Business Phone:

Fax:

Current Insurance Company

Company Name:
(not agency)

Policy Expiration Date:

Current Insurance Coverages

CurrentCoverages:

Bond
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
Disability
Group Health
Group Life
Professional Liability
Workers' Compensation
Other

Business Information

# of Full-Time Employees:

# of Part-Time Employees:

How long in Business? (yrs)

How many locations?

Please give a brief description of your business and clientele:

Property/Premises Information

Address:

Occupancy Status:

Owner
Tenant

Year Built:

% Occupied:

Sprinklers:

Yes
No

Construction Type:

Stories:

# Basements:

Sq. Footage:

Burglar Alarm:

Yes
No

Building Value:

Contents:

Other Property (specify):

Insurance Information

Other:

Annual Gross Sales: (before taxes)

Number of Employees:

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:

Additional Comments:

Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.

| Privacy

Built by The Content Squad