Business Insurance Quote

Ready to receive your free quote? Fill out the form below and click the "Submit" button at the bottom of the page. We can also help you at 800-950-6007, ext. 2030. Information is required unless noted as optional.

All fields marked with * are required.

Quote Selection

Select the product(s) for a quote:(Optional)

Business Owner's Protection Worker's Compensation Insurance Other (Business auto, flood, earthquake, etc.)

Contact Information

First Name: *

Middle Initial: (Optional)

Last Name: *

Business Name (or DBA): *

Mailing Address: *

P.O. Box, Apt., Ste., etc. (Optional):

City: *

State: *

Please contact Professional Solutions to inquire about availability of coverage in Florida. 1-800-769-2000, ext 8180 or agents@ncmic.com.

ZIP: *

Phone: *

Business Fax (Optional):

Email: *

Is your business address the same as the mailing address?: *

Yes No

Address

Business Address: *

P.O. Box, Apt., Ste., etc. (Optional):

City:*

State:*

Please contact Professional Solutions to inquire about availability of coverage in Florida. 1-800-769-2000, ext 8180 or agents@ncmic.com.

ZIP:*

Preferred Contact Method: *

Do you have employees? *

Yes No

Total number of employees: *

Business Information

Number of years you've been in business: *

Gross annual business receipts: *

Percent revenue from supplement sales: *

Do your business operations involve growing, storing, selling, dispensing, manufacturing/processing or otherwise providing access to medically-prescribed or recreational marijuana? *

Yes No

Facility Information

Do you own the building? *

Yes No

Building Info

Total square feet of building: *

Replacement cost of building (Optional):

Building Construction: *

Frame - Primarily wood frame construction with siding or stucco on exterior Brick - Exterior wall is primarily brick, concrete, or stone Concrete - Interior and exterior construction is built primarily of concrete block Other - Includes: metal frame, structural steel, fire resistive

Year built: *

Square feet of your business: *

Updates

Year of last updates to: (Optional)

Roof:
Electrical:
Plumbing:
Heating:

Number of stories: *

Value of contents: *

Professional Solutions provides the insurance quote based on replacement cost of contents. Please use a dollar amount based on what it would cost to replace the items today if purchased new.

Value of tenant improvements: *

If you have not made any physical improvements to your business location, please state "None".

Coverage and Quote Information

Have you filed a claim for your office insurance in the last 5 years? *

Yes No

Claims

How many claims? *

Date of claim (mm/dd/yyyy): *

Please provide reason: *

Amount paid: *

Choose a liability coverage amount: *

$1,000,000 per claim / $2,000,000 per year $2,000,000 per claim / $4,000,000 per year

Do you currently have Business Owners' Coverage? *

Yes No

Carrier

Insurance carrier name: *

Other Insurance Carrier Name: *

Renewal date (mm/dd/yyyy) (Optional):

Do you have multiple business locations? *

Yes No

Other Locations

A Professional Solutions insurance representative will contact you for information about your other locations.

Employee Information

Are owners/principals included? *

Yes No

Estimated Owners/Principals Annual Payroll: *

Estimated Employee Annual Payroll: *

Employer Federal I.D. Number: *

Have you had any workers' comp. claims in the past 5 years? *

Yes No

Workers Comp

How many claims? *

Date of claim (mm/dd/yyyy): *

Amount paid: *

Comments

Additional information or comments (Optional):

(maximum 2000 characters)

Once your completed information is received, a representative will contact you.

Customized Business Insurance Coverage Designed for Dentists