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Commercial Property Rate Request

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For your quote to be of the highest accuracy, please complete all fields.

* Name		* E-mail
* Street		* City
* State		* Zip
*County
* Home Phone		Work Phone
Fax Phone

Business Information

Doing Business As

Mailing Address

Company web address

Short descriptionof your business

Type of Business

Effective Date for Coverage to Start

Contact Person

Name		E-mail
Address		City
State & Zip		Phone Number

Property Section - up to two locations, each one up to three buildings.
If there are more buildings / locations, please contact us at 800-541-9849

LOCATION 1
Building 1
Subject of Insurance	Amount	Valuation	Causes of Loss	Deductible
Building
Contents
Stock
Extra Expense
Building 2
Subject of Insurance	Amount	Valuation	Causes of Loss	Deductible
Building
Contents
Stock
Extra Expense
Building 3
Subject of Insurance	Amount	Valuation	Causes of Loss	Deductible
Building
Contents
Stock
Extra Expense
LOCATION 2
Building 1
Subject of Insurance	Amount	Valuation	Causes of Loss	Deductible
Building
Contents
Stock
Extra Expense
Building 2
Subject of Insurance	Amount	Valuation	Causes of Loss	Deductible
Building
Contents
Stock
Extra Expense
Building 3
Subject of Insurance	Amount	Valuation	Causes of Loss	Deductible
Building
Contents
Stock
Extra Expense

More Information on Each Building - once again, up to two locations, each one up to three buildings.
If there are more buildings / locations, please contact us at 800-541-9849

Loc #, Bldg #	Inside/Outside City Limits	Distance to Fire Hydrant	Distance to Fire Station	Year Built
Loc 1 , Bldg 1
Loc 1 , Bldg 2
Loc 1 , Bldg 3
Loc 2 , Bldg 1
Loc 2 , Bldg 2
Loc 2 , Bldg 3

Loc #, Bldg #	Type of Construction	Total Area	Roof Type	# of Stories	# of Basements
Loc 1 , Bldg 1
Loc 1 , Bldg 2
Loc 1 , Bldg 3
Loc 2 , Bldg 1
Loc 2 , Bldg 2
Loc 2 , Bldg 3

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