Business Insurance Quote

ALC Risk Solutions


* Name
*Company Name
Website:
* Email Address:	Invalid Email
Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Best Time To Contact:
Contact By:

Current Policy Information
Property Insurance Company:
Property Premium:	Including Windstorm?
Property Expiration Date:
General Liability Insurance Company:
General Liability Premium:
General Liability Expiration Date:

Liability Information
Years In Business:
Number of Locations
Annual Gross Revenue
Annual Payroll (estimated)
Describe Business:
Any Products manufacturered by the applicant, or relabelled under applicant's name?:	Yes No
If Yes, describe:

Property Information
Building Owned by Applicant Commercial Condo Applicant is a Tenant
Year Built:
Construction (if known):
Stories:
Square Feet:
Has the Electrical System been updated?	Yes No If Yes, Year:
Has the Plumbing Been Updated?	Yes No If Yes, Year:
Has the Roof been Updated?:	Yes No If Yes, Year:
Has the Air Conditioning Sytem been Updated?:	Yes No If Yes, Year:

Additional Underwriting Questions
Have you been cancelled, non-renewed oe declined for insurancein the past 3 years?
Has the applicant had a foreclosure, repossession, bankruptcy, judgment or lien in the past 5 years?
Has the applicant been involved in any lawsuits, or had any judgements or leins against them in the past 5 years?
Are any other business operations owned by the applicant, or any owners of the applicant company?
Would you like ALC Risk to quote any other lines of insurance for you?
What other lines of insurance would you like a quote for?

Additional Information Please list additional vehicles, drivers or other pertinent information to help expidite the underwriting process.

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