Business Insurance Peoria - Ledbetter Insurance

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

Ledbetter Insurance Business Owners Insurance Quote Form

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

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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:

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Contact Information

Name*

First Last

Position*

Best Method of Contact*

Phone

Text

Fax

Phone Number*

Best Time to Contact*

Comments

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