Request A Quote

For the fastest & most accurate response, please fill in as much as possible

For the fastest & most accurate response, please fill in as much as possible

For the fastest & most accurate response, please fill in as much as possible

For the fastest & most accurate response, please fill in as much as possible

Commercial Insurance Quote

Your Name *

First

Last Name *

Last

Phone *

Email *

Business Name *

Federal Tax ID (optional)

Not required at this time, but we will need it at a later time

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

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Country

What type of coverage are you seeking? Select all that apply *

General Liability

Business Owners Policy (BOP) or Commercial Policy Package (CPP)

Commercial Property

Commercial Auto

Workers Compensation

Years in Business * – Please select –Less than 1 Year12345678910+

How many years has the business been operating?

Years of experience in the Industry? * – Please Select –0 – 1 Years2-3 Years4-10 Years10+ Years

How many years of experience do you have in the industry?

Number of Employees *

Please enter the total number of employees (Including part time and yourself)

Projected Annual Revenue * – Please Select –Under $100,000$100,000 – $200,000$200,001 – $300,000$300,001 – $500,000$500,001 – $750,000$750,001 – $1,000,000$1,000,000 +

What is the approximate Projected Annual Revenue from your business

Total Value of Personal Property

Brief Description of the business *

I.E : I am general contractor that renovates homes, HVAC company, run a marketing company, etc..

Would you like to fill out the Worker Compensation questions now?

Yes

No

Workers Compensation Questions

Current Carrier (If any)

List any Class Codes from Current or Prior Policies? (optional)

If you know the class codes, please enter them here

Do You Prefer Owners to be excluded from the Policy? *

Yes, Exclude the owners

No, Include the owners

Owners Salary *

Please enter in the total owners salary to be excluded

Have You Had Any Claims or Coverage Lapses Over Last 3 Years? *

Yes

No

Please include any information on the claim or coverage lapse

Would you like to fill out the Commercial Auto questions now? *

Yes

No

Provide Driver information now? *

Yes

No

Driver Information

First Name *

Last Name *

Birthday (Optional)

Required for an accurate proposal

Drivers License Number (Optional)

Required for an accurate proposal

Drivers License Issuing State * AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY

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Provide Vehicle information now? *

Yes

No

Vehicle Information

To get a more accurate proposal a VIN number for Vehicle would be required.

Use Vin Number or Type in Make/Model/Year *

Vin Number

Make/Model/Year

Vin Number *

Please enter your VIN number

Select Year * 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024

Select Make *

Select Model

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Is there anything else that you’d like us to know before contacting you?

File Upload

Drop a file here or click to upload Choose File

Maximum file size: 104.86MB

Please attach files that you would like us to have

I acknowledge that Gordon Insurance will run a report in order to collect additional information in order to get the most accurate insurance proposal

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Submit

For the fastest & most accurate response, please fill in as much as possible