Business Insurance Peoria - Ledbetter Insurance

LOCAL INSURANCE ADVICE · PEORIA, ILLINOIS

MON–FRI 9AM–5PM • 309-673-5544

You can be assured your data is secure with us and Honesty is our Gold Standard

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.

"*" indicates required fields

1Personal Information

2Underwriting Information

Phone

This field is for validation purposes and should be left unchanged.

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

Text

Fax

Phone Number*

Best Time to Contact*