Texas General Liability Insurance Quote

Please provide us with a little information:

Business Owner:

First Name
Last Name
Name of Business
Street Address
City
State
Texas Based Only!
Zip Code
Phone
E-mail

(Please select your type of business below)

Is this a new business?
 Yes No
Is the business owned by a?
How many years of experience?
 (Leave Blank if New)
How many years in business?
 (Leave Blank if New)
What limits do you need?
Additional Insureds ($100.00 each, Max 5)

Previous Insurer Information
Who is your previous insurance carrier?
Are they nonrenewing you? Yes No
Give a discription of any losses in past 5 years.

 
Full Time
Part Time
Numbor of Employees
What is your payroll minus (Owners, Partners, or Corporate Officers)?
(Leave Blank if New)
What is the payroll for Owners, Partners, or Corporate Officers?
(Leave Blank if New)
What are your gross receipts?
(Leave Blank if New)
What are your gross sales?
(Leave Blank if New)
What percentage of your work is contracted to subcontractors? %
Do you desire coverage for your subcontractors? Yes No
Do you request Certificates of Insurance, from you subcontractors? Yes No
What type of work do you subcontract out?

If Insuring Building
What is the square footage of the building? sq.ft.
How many separate units does the building have?

Any questions or comments?

Double check all information before you submit or you might not get the right quote.