Business Insurance Quote – Zurita Insurance & Financial Services

Skip to content

Home
About
Get a Quote
Policy Service
Contact Us

Home
About
Get a Quote
Policy Service
Contact Us

Business Insurance Quote

Agent Submitting this Request:

Submitted By: *

How can we help protect your business?

You may choose more than one.

How can we help protect your business? *

Business Owners
General Liability
Workers' Compensation
Commercial Auto
Umbrella
Commercial Property
Professional Liability (E&O)
Other (describe below)

Other Coverage *

Great, please tell us about yourself!

Applicant Name *

First

Last

Phone *

Date of Birth *

Email *

Preferred Language

Applicant Address *

Address Line 1

City

State

Zip Code

Tell us about your business!

Business Type *

Individual / Sole Proprietorship
Limited Liability Company (LLC)
Corporation
Association
Limited Liability Partnership (LLP)
Trust

Business / DBA / Association Name - if applicable

Tax ID / Federal Employer Identification Number / Social Security Number *

*Required for workers compensation

Layout start DBA

Are you a contractor?

Yes
No

e.g: carpenter, painter, landscaper, etc.

Business Description: *

Work being performed:

Class of business *

Please provide a brief description of the products/services that you offer: *

What year did you start your business? *

Number of years continuously insured *

Reason for no prior insurance *

What are your estimated annual gross sales? *

What are your estimated annual common charges? *

Do you have W2 employees? *

Yes
No

Number of Employees *

Annual Payroll *

Do you hire subcontractors? *

Yes
No

% of work by subcontractors *

Do you have a physical business location? *

Yes
No, I use my home address

Business Location

Address *

Address Line 1

City

State

Zip Code

Do you own or rent this location? *

Own
Rent

Approximately how many square feet does your business occupy? *

How much business contents coverage do you need? *

Enter total value of furniture, inventory, computers, etc.

Does your business location have any of the following? *

Central burglar alarm
Central fire alarm
Sprinklers
None

Property Location

Address *

Address Line 1

City

State

Zip Code

What year was the roof last replaced? *

Number of Units *

Does your business location have any of the following? *

Central burglar alarm
Central fire alarm
Sprinklers
None

Occupancy Type *

Remarks (optional)

Association Address

Association Address *

Address Line 1

City

State

Zip Code

Amenities *

Pool
Playground
Detached Parking Garage
Community Room
Fitness Center
None

Safety Features *

Sprinklers
Gated Community
Security Guard
Central fire alarm
None

Building

Number of Units *

% Occupied by Tenants *

Building Square Footage *

Number of Floors *

Roof Age *

Any commercial tenants? *

Does your business have any vehicles? *

Yes
No

Does the Association own any vehicles? *

Yes
No

Vehicle

Year *

Make/Model *

e.g. : Toyota Tacoma

VIN

Driver

Name *

Date of Birth *

License Number *

License State *

You're almost done!

Great job! you've completed your application. Now is your chance to give us any last-minute details that will help us provide the best quote for you. Are there special circumstances we should take into account? Are you not sure if you answered a question correctly? Let us know!

Additional Remarks:

Related Documents (Optional):

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 10 files.

Camera Preview

3

Example: Copy of current policy, COI requirements, etc.