Parsons & Associates, Inc. -- Business Insurance Proposal Form

Parsons & Associates. Inc. -- Insurance & Risk Management

Business Insurance Proposal Form
For the fastest and most accurate business insurance proposal, please provide as much information possible in the form below. This information will be kept confidential and will be used for proposal purposes ONLY!

This Online Application is on a Secure Server. Click on the seal on the left for more information on the certificate's authentication. Privacy Statement: Any information provided by a consumer or customer via our online forms WILL be held in the strictest confidence. No information will be shared with others. Our goal is to respond to all submissions within two business days.

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We only accept inquiries for insurance written in New York State

General Information

Name of Business:

Contact Name:

Street Address:

City: State: ZIP:

County: Email:

Business Phone: ( ) - Fax: ( ) -

Best time to call: AM PM

Current Insurance Company (not agency):

Company Name:

Policy Exp. Date:
/ /

What type of coverages do you currently have:

Bond
Commercial Auto
Commercial Liability
Commercial Property Commercial Umbrella
Directors & Officers Liability
Disability
Group Health Group Life
Professional Liability
Workers' Compensation
Other

About Your Business:

# of full-time employees # of part-time employees How long in business How many locations Annual Sales

yrs. $

Please give a brief description of your business and clientel:

Please select the type of coverages you want:

Bond
Commercial Auto
Commercial Liability
Commercial Property Commercial Umbrella
Directors & Officers Liability
Disability
Group Health Group Life
Professional Liability
Workers' Compensation
Other

Additional Comments:

Please give any additional comments about the coverage you desire:

Thank you for your time in submitting this Business Insurance proposal form. One of our representatives will respond to your submission as soon as possible!