BMP Insurance Services

Commercial Insurance Quote

Commercial insurance is designed to help protect you against many of the risks your business can face, including:

Damage or destruction to your business vehicles
Certain liability exposures resulting from the operation of your business vehicles
Damage or destruction to your office equipment or inventory
Loss of income in case you have to close-up shop temporarily because of a covered loss
Certain business related liability exposures such as, wrongful entry or search, libel, slander and even certain offenses arising out of your business’s advertising
Risks to your cargo while in transit or storage
Theft or loss of tools and equipment
Crime coverage including robbery, burglary, and even employee dishonesty.

BUSINESS INFORMATION
Company Name:

Industry Category:

Business Description: (no less than 10 words)

Form of Business:
State of Business Location:
Years in Business:
Years Industry Experience:
Annual Gross Sales: (last 12 months)
Estimated Gross Sales: (next 12 months)
Number of Locations:
Total Number of Owners, Officers & Directors:
Total Number of Employees:
Annual Gross Payroll: (excluding Owners, Officers & Directors)
# Full-Time Employees:
# Part-Time Employees:

PRIOR INSURANCE

Have Prior Business/ Commercial Insurance?
If Yes, Select Insurer:

If "Other Insurance" - Name:
Time With Insurer:
Estimated Yearly Premium:
Policy Ends On:

COMMERCIAL INSURANCE TYPES
Please indicate which types of insurance you are interested in:
General Liability Business Owners Policy Commercial Auto Workers' Compensation Group Health Other
Referred By:

APPLICANT'S CONTACT INFO
First Name:

Last Name:

State:

E-Mail Address:

Business Phone:

Business Fax:

Comments: