Business

MetroplexInsurance.com offers the following coverages for your business:

General Liability	Workers Compensation
Property	Auto
Umbrella	Cargo
Garage	Group Health Plans
Worksite Employee Benefits	Contractors
Lessor Risks	Vacant Property
Retail Stores	Manufacturers
Builders Risks	Apartments
Restaurants	Software Companies

Please fill out the form below for a no obligation Business quote.
If you are unsure of the information to fill out, please just complete the "General
Information" section and we will contact you:

General Information
*All Principals Full Names
*Name of Business
*Address
*City
*State
*Zip Code
Mailing Address(if different from above)
*Phone
Fax
*Email
Website
*Years in Business
Years Experience (if individual)
*Nature of Business/Description
*Legal Classification	Select OneIndividualPartnershipS-CorporationC-CorporationLLPLLCOther
*Federal Tax ID/Social
*Describe all claims in the last 7 years
*Coverages Requested (check all that apply)	General Liability Property Business Auto Garage Workers Compensation Umbrella Other
General Liability Coverage (Optional)
Each Occurrence $
General Aggregate $
Gross Sales $
Payroll $
Number of Employees
Area in Sq. Ft.
Additional Insured
Property (Optional)
For	Building   Contents   Both
Description
Amount $
Replacement Cost $
Actual Cash Value $
Deductible Amount $
Construction Type
Year Built
Number of Stories
Burglar Alarm Type
Sprinklers	Yes   No
Total Area (Sq. Ft.)
Other Occupancies
Right Exposure
Left Exposure
Rear Exposure
Business Auto (Optional)
Name/Gender/Marital Status/DOB/License Number/SS#/Reason/For all Employees
Year/Make/Model/Vin#/Cost New of Each Vehicle
Deductible for Comprehesive $
Deductible for Collision $
Business Auto (Cont. - Optional) Look at Existing Coverage to Answer
BI Occurrence $
BI Aggregate $
PD Occurrence $
Medical or PIP $
CSL $
Radius of Operation (in Miles)	<50   50 - 150   150 - 300   >300