Business Owners Insurance Quote Form 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. 1 Personal Information2 Underwriting Information Type of BusinessSole ProprietorPartnershipLLCCorporationYour NameBusiness Name:Property Address:City:State:IllinoisIndianaIowaMissouriOhioWisconsinZip/Postal Code:Email:* Phone:Fax (Optional):Currently Insured? (If yes, list carrier, and # of years continuous. If none, type NONE)Type of Business:RetailWholesaleOfficeOtherList 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 DesiredThe Coverage I Am Looking For:Liability OnlyLiability & Business ContentsLiability, Building & Contents CoverageA Package Policy Including the Above, Plus Miscellaneous CoveragesNOTE: 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:Commercial VehicleBonds, License/PerformanceWorkers CompensationBuilders Risk InsuranceCommercial UmbrellaSend my quotation via:E-MailFaxRegular MailCall me by PhoneContact InformationName* First Last Position*Best Method of Contact*PhoneEmailTextFaxPhone Number*Best Time to Contact* : HH MM AM PM NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.