Business Quote - The Haessly Insurance Agency

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Business Owners Quote

* Indicates required field

Name *

Email *

Phone *

Address *

City *

State *

Zip *

Interested In *

Business Owner's Policy Commercial Liability Policy Artisan Contractor Policy Commercial Auto Policy Surety Bond Other

Check all that apply.

Currently Insured? *

Yes No

Name of Insurance Carrier *

How Long Insured With Them? *

Any Claims Last 5 Years *

Yes No

Proposed Effective Date *

Your Business

Business Name or DBA *

Address (if different than above) *

Number of Years in Business *

Company Type *

EIN *

Number of Owners, Members or Officers *

Annual Gross Receipts *

Annual Payroll *

Number of Employees *

Describe Your Business *

Your Operations

Day to Day Operations *

Retail Wholesale Restaurant Contractor Construction - Residential Construction - Commercial Delivery Trucking Charitable Organization Other - explain below

Check all that apply.

More about your operations *

If contractor, years experience *

Percentage of work residential *

Percentage of work commercial *

Your Property

Type of Property *

Square Feet *

Value of Business Property *

Year Building Built *

Building Construction Type *

Occupancy Type *

Value of Building (if you are the owner) *

Protection Devices (check all that apply) *

Smoke Detector Burglar Alarm Fire Sprinklers Fire Alarms Fire Extinguishers Deadbolts Monitored Security System

Your Vehicles

Number of company vehicles *

Describe types of vehicles *

Describe vehicle operations *

Trucking, construction, retail or wholesale delivery, contractor vehicle, etc.

Radius of operation *

Less than 50 miles 51-100 miles Over The Road Interstate

Check all that apply.

Additional Comments

Comments: *

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CONTACT US (CA & AZ)

CONTACT US (TX & OK)

PERSONAL LINES

BUSINESS LINES

The Haessly Insurance Agency
Phone: (619) 567-9113
Email: [email protected]

CA Lic # 0C02587
AZ Lice# 2651426
Privacy

Josh Haessly Agency
Phone: (817) 868-5566
Email: [email protected]

TX Lic # 2876341
OK Lic # 3002325746
Privacy

Auto Insurance
Home Insurance
Life Insurance
Renters Insurance
Umbrella Insurance

Business Insurance
Commercial Liability
Contractor Insurance
Commercial Insurance
Surety Bonds

Home
About
- Our Promise
- Privacy
Realtors & Lenders
- Refer a Client
Quotes
Contact
Products
Refer a Friend
Self-Storage