Business Insurance

AGI
About
Services
Contact
CIGAR & SMOKE SHOPS

AGI Commercial

This submission is a request. Insurance coverage changes and new coverage are not effective until we confirm that for you in writing.

We will do our best to furnish a quote based on the information you provide. The more complete your information, the more accurate your quote will be.

We follow the highest industry standards to safeguard the confidentiality of your personal information and secure the transmission of your information from your computer. Please fill out this form as completely as possible to ensure an accurate quote.

Annual Sales:

Vehicle Travels

Interstate

Intrastate

Both

If Yes, what is the replacement cost:

Do employees drive company vehicles

Yes

Business Name: *

Contact Email: *

Zip Code:

Company Vehicles

Yes

Does the company hire or rent vehicles

Yes

Square Footage:

If Yes, is the system:

On Premisis

Monitored by 3rd Party

Business Insurance

Applicant Name: *

Thank you for contacting us! If needed, you will hear back within 48-72 hours.

Business Facilities

Owned

Leased

Value of Computers:

Value of stock/Inventory

Any bankruptcies, tax or credit liens within the last five years? If Yes, please explain

Years in Business:

Number of stories:

Number of Full Time employees:

FEIN/Tax ID Number:

Current Insurance Carrier:

Application for Quote

Is this a New business?

Yes

If Yes, list the states:

Exterior Signs

Yes

If Yes, how many:

Alarm System

Yes

If Yes, radius driven

Required *

I understand that any policy changes and quote requests are effective only when I have received a written confirmation.

Value of building & tenant improvements if responsible:

Business Phone *

Business Address

Number of Part Time / Contract employees:

Describe your business *

Date of Next Renewal

Legal Entity

Sprinkler System

Yes

Entity name on Lease or Deed:

Number of owners, partners, etc.:

Current Premium:

Additional Insured:

Does the company operate in any other states

Yes

Any insurance claims within the last five years? If Yes, please explain

Year Built:

Construction Type:

Years of Experience:

Value of office equipment/furniture

Annual Payroll:

Additional DBA(s):

View on Mobile