Experience and Expertise

  • Access to top A rated insurance companies with policy coverage's and pricing to match their excellent record of service
  • Family First has over 25 years of combined experience in the insurance industry
  • Highly automated systems for fast policy processing that are geared towards service to our client base and referral source

Commercial Insurance Quote Request Form

Requestor Information

*Contact First Name: Required.
*Contact Last Name: Required.
Contact Number:
*Referred by: A value is required.
We will send the evidence of insurance to any Fax, Email, or Secondary box completed below.
So only fill out the box or boxes you want the evidence(s) returned too.
Fax:
*Email: Required.
Secondary Fax or email:
*Website: Required.

Client information

*Name of business: Required.
*Corporation      Partnership      Individual      Association      LLC     Other  
*Fed id#: Required.
*Prior/Current Address: Required.
*Location address: Required.
Own      Rent  
*Years in business: Required.
*Any bankruptcies in the last 5 years? Please select an item.
If so - Discharge date:
*Detailed description of business operations:
Required.
Type of insurance needed
*General Liability      Business Auto      Commerical Property      Workers Comp      Umbrella  
Rating information
*Current Insurance Company: Required.
*Expiration date of current policy: Required.
*Number of claims in the last 3 years: Required.
Date: What happened:
Date: What happened:
Date: What happened:
Date: What happened:
*Annual sales: Required.
*Annual rents: Required.
*Annual payroll: Required.
*Restaurant/bar sales:
Food:      Liquor:      Gaming:  
Number of employees:
*Fulltime:   Required.    *Part time:   Required.
*Buiding Construction:  Frame      Jointed masonry     
Square Footage:
*# of stories: Required.
*Year built: Required.
*Sprinklers? Please select an item.
*Fire alarm connected to central station? Please select an item.
*Burglar alarm connected to central station? Please select an item.
Driver's and automobile (list 1 driver with each automobile below) if you have 8 trucks and 11 drivers list the 8 drivers with the best driving history
Driver Name DL Number Date of Birth VIN # Year Make Model
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Month Day Year
Current Coverage's Section. Select coverage's or if you want basic CGL all inclusive type this in the notes section
Amount of coverage:
*Building amount:   Required.    *Property contents amount:   Required.    *Liability:   Required.
*Loss of business income:   Required.    *Signs:   Required.  
*Deductible:     $500      $1,000  
*Liability Coverage: Please select an item.
*Property Damage: Please select an item.
Collision Deductible:
Comprehensive Deductible:
If the building is over 20 years old, what year were updates done?
Wiring:
Heating:
Plumbing:
Roof:
Please type any notes or special concerns you may have below: