General Liability / Contractors Quote Form

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Ledbetter Insurance Commercial General Liability Insurance Quote Form

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):
Number of Years Experience
Number of Years in Business

Date Coverage Needed:
MM slash DD slash YYYY
Prior Carrier:
Describe Business:
Gross Annual Receipts:
Gross Annual Payroll:
Square Footage of Your Business Location:
Number of Employees:
Prior Claims?
Describe claims in detail:
Limits and Coverages
Liability Limits
Business tools and/ or equipment needed? If so, list type and amount:
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.