Home
Resources
FAQ
Contact Us
About Us
Personal Insurance
|
Business/Commercial
|
Quotes
Business Quote Factfinder
Welcome to the Rolland Insurance Business Quote Factfinder. By completing this simple and easy form we'll be able to get you the information you need quickly and easily. If you have any questions, please do not hesitate to contact us at 614-789-1891.
*
= Required
Name:
*
Phone:
*
Email:
*
Best Time to Contact:
Select One
Morning
Afternoon
Evening
Anytime
Address:
*
City:
*
State:
*
Zip:
*
Description of Business
Please tell us a little bit about your business :
Miscellaneous Information
Number of Employees:
Estimated Gross Sales :
Select One
Under $100,000
$100,000 - $250,000
$250,000 - $1 Milliom
$1 Million - $5 Million
5 Million +
Start of Business:
Prior Carrier Information
Prior Carrier:
*
Years with Company:
Preferred Liability Coverage:
Select One
$12,000/$25,000
$25,000/$50,000
$50,000/$100,000
$100,000/$300,000
$300,000/$300,000
$500,000/$500,000
Other or Unknown
(i.e. if coverage is $100,000/$300,000 - the $100,000 is per person, $300,000 is per incident):
Property Coverage Needed:
History
List all losses/claims in the last 3 years:
*
= Required
Home
|
Resources
|
FAQ
|
Contact Us
|
About Us
162 W. Olentangy St. Powell, OH 43065 | 614.789.1891
© 2008 Rolland & Associates Insurance
site crafted by
Robintek
