Mike Arnold Agency
looking for clear & simple
life insurance?
car insurance
our company is recommended by
98%
of our clients
business insurance
when you feel confident about
the future you can carve more
fun out of the present
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Commercial Quote
Owner's Name
Phone Number
Contact Name (if different)
Name of Business
Mailing Address
Address
City
State
Zip
Physical Address (If Different)
Street
City
State
Zip
Do you own or rent location?
Own
Rent
Detailed Description of Business:
What kind of coverage are you looking for? (Check all that apply.)
General Liability
Worker's Compensation
Business Auto
Business Umbrella
Federal ID #
Entity Type
Sole Proprietor
LLC
Corporation
Partnership
Other
Length of time in Business
Years of Experience in Industry
*
Do you currently have insurance? With who, and for how long?
Any claims in the last five (5) years?
Yes
No
Describe Claims
Do you use Sub-contractors?
Yes
No
If so, what is your Annual Sub-Contractor costs?
Employee Payroll (not including owner(s))
Gross Annual Sales (if new venture please estimate)
Complete for Business Auto Only (click to expand)
Driver Info - Name:
Date of Birth
Filings needed
None
SR-22
FR-44
Are you for hire?
Yes
No
If yes, do you require an additional filing?
Years CDL Experience? (if applicable)
Do you wish to add another driver?
Yes
No
Additional Drivers
Additional Driver
Name:
Date of Birth
Filings needed
None
SR-22
FR-44
Are you for hire?
Yes
No
If yes, do you require an additional filing?
Years CDL Experience? (if applicable)
Add Another Driver
Remove
Vehicle Information
Vehicle Information
Full Coverage?
Yes
No
If Yes, select Comprehensive deductable
$250
$500
$750
$1000
If Yes, select Collision deductable
$250
$500
$750
$1000
Is there a lien holder?
Yes
No
Vehicle Info - Year:
Make:
Model:
VIN (if known)
Add Another Vehicle
Remove
Notes (Additional Info)
