General Liability / Contractors Quote Form

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.

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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):

Number of Years Experience

Number of Years in Business

Date Coverage Needed:

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:

Liability Limits

Business tools and/ or equipment needed? If so, list type and amount:

Send my quotation via:

Name*

First Last

Position*

Best Method of Contact*

Phone

Text

Fax

Phone Number*

Best Time to Contact*

Name

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