Business Insurance Peoria - Ledbetter Insurance

Any Business and all insurance lines offered Call 309 673-5544

We would love to hear from you! Please fill out this form and we will get in touch with you shortly.

1Personal Information

2Underwriting Information

Type of Business
- Sole Proprietor
- Partnership
- LLC
- Corporation
Your Name
Business Name:
Property Address:
City:
State:
Zip/Postal Code:
Email:*
Phone:
Fax (Optional):
Currently Insured? (If yes, list carrier, and # of years continuous. If none, type NONE)
Type of Business:
List Claims & Amounts Paid (If none, type NONE)
Years In Business:
Business type: (proprietorship, corporation, etc.)
Describe Business in detail: (i.e., Delicatessen and sandwich shop, etc.)

Describe IN DETAIL, Your Business Operations:
Ownership & Payroll Data:
List Employee's Annual Payroll Here (if none, enter $0):
Insert # of Employees here:
Location & Sales Information:
Insert Annual Gross Revenues from this operation here:
Square Footage of office or business location:
Type of Building (wood frame, concrete, etc.):
Number of Stories:
Are there other business/residences in this building (describe)?:
Describe safety features (alarm, sprinklers, fire protection, etc):
Coverage Desired
The Coverage I Am Looking For:
NOTE: Don't worry if you are not exactly sure about coverage type... we will suggest the best coverage for you - just try to tell us what you are looking for! (If we need more info. we will let you know.)
Liability Coverage: ($300,000, $500,000, $1 Million, etc.)
Business Contents Coverage: (The amount of your personal business property)
Building Coverage: (The amount of building coverage if you own your bldg.)
Miscellaneous Coverage: (List any special coverage peculiar to your business, such as Garagekeepers Legal, Loss of Earnings, Valuable Papers, etc.)
Other Coverages You Would Like Information On:
Send my quotation via:
Contact Information
Name*
First Last
Position*
Best Method of Contact*
- Phone
- Email
- Text
- Fax
Phone Number*
Best Time to Contact*

: Hours

Minutes

AM/PM
Comments
This field is for validation purposes and should be left unchanged.

Ownership & Payroll Data: