BUSINESS INSURANCE QUOTE FORM

Peterson Insurance Services, Inc. is extremely pleased to be able to offer you the finest protection through Erie Insurance, an A+ rated carrier by A.M. Best. We have an impressive collection of property, casualty, and life products that can be tailored to meet your specific needs in today's business environment.

We offer all lines of business insurance at competitive rates:

  • Contractor's Insurance
  • Property and Liability Package Policies
  • Worker's Compensation
  • Business Catastrophe Liability (Commercial Umbrella)
  • Bonds

To receive more detailed information on our quality lines of business coverage or to request a quote, complete the form below and click the submit button. We will contact you promptly.
BUSINESS INFORMATION
First Name:
Last Name:
Name of Business:
Type of Business:
E-Mail Address:
Address:
City:
State:
Zip Code:
Phone Numbers:

Daytime:
Evening:
Fax:
Cell:

Years in Business:
Policy Period :
How would you prefer to be contact regarding your quote? Phone    Fax    Email   

Business Entity:

Location Address: Street:
  City:
  State:
  Zip:
Interest of Premises:
Program:
Description of Operations:
Mortgagee name & address:
LIMITS OF INSURANCE and OPTIONAL COVERAGES
Building:
Replacement Cost:
Actual Cash Value:
Construction: Frame    Joisted Masonry
Masonry: Noncombustible    Fire Resistive
Sq. foot area of each building:
Sq. foot area occupied by applicant:
Year of Construction:
Number of stories:
Business personal property:
Deductible:
Exterior Glass: Yes    No
Sign: Yes    No
Money & Securities
$10,000 Inside/$2,000 Outside
>Systems breakdown/ boiler & machinery Yes    No
Non-owned & Hired Automobile Yes    No
Annual Sales:
Annual Payroll:
Accounts Receivable:
Valuable Papers:
Business Computer Hardware:
Business Computer Software:
Employee Dishonesty:
Business Liability:
Additional Insured Name and Address
3 YEAR PRIOR CARRIER
Policy 1 # Expiration Date:
Premium:
Policy 2 # Expiration Date:
Premium:
Policy 3 # Expiration Date:
Premium:
LOSS HISTORY
1) Date of Loss: Loss Description:
Amount Paid for:
2) Date of Loss: Loss Description:
Amount Paid:
3) Date of Loss: Loss Description:
Amount Paid:
REMARKS:


How Did You Hear About Us?
COVERAGE INFORMATION
Quote requested within:
 24 hrs 48 hrs 72 hrs 120 hrs