Submit the following information for a quote:  *Required Information

There is no obligation and the quote you request will be sent to you within 24 hours.  The accuracy of the quote depends on the accuracy of the information you provide.

Name:* 

Address:

Zip / Postal Code:*     Phone: 

E-mail:*

Business Information

What type of business do you operate?  Please be specific.*

* Insurance needs of different business types vary greatly.  This form is designed to gather generic rating information.  If your business has special insurance needs or requires more detailed information one of our commercial insurance specialists may need to contact you directly in order to get you an accurate rate comparison.

Do you own a building?       Yes     No

If you own, give the building value:  

What year was it built?  Or approximately how old is it? 

What Type of Construction is it?  Brick / Masonary Other Frame Aluminum Frame Stucco

What is the total Value of property and/or
equipment you use in your business?         

What is the maximum value you may have at one time?   

What is the square footage of the space you occupy?    

How many employees do you have (including yourself)?  Full Time 
                                                                                                 Part Time

What amount of Liability coverage do you need?  $100,000 / $300,000 $300,000 / $600,000 $500,000 / $1,000,000 $1,000,000 / $2,000,000

Do you have vehicles used in business?   Yes     No

If so, please list year, make and model:

How long have you been in business?    

Do you have a monitored security system?       Yes   No

Have you had any bankruptcies, foreclosures,
or repossessions in the past 5 years?                  Yes   No

Have you had any claims in the past 3 years?     Yes   No

If so, please list details:

Employee Benefits

Do you have  group health, dental, or life ins.?     Yes   No

Do you have a 401(k) or other retirement plan?   Yes   No

Do you have workers compensation insurance?  Yes   No

Would you like information on these benefits?      Yes   No

Which Agent do you prefer to do business:  Any Agent Calvin J. Heiner J. Shawn Heiner Dennis R. Stone L. Todd Erickson Douglas P. Bronson Wesley East Marvin S. Rabe Marsha Losee Melissa Bell Heather Wade Curt Oda Fred Mullins Kerry Norris Reed Heslop Blake Cevering

Thank You!  That is all the information we need to process a rate comparison on your business insurance.  NO INSURANCE COVERAGE CAN BE STARTED THROUGH THIS PROCESS.  If you need immediate coverage please call the office nearest you.