Professional Liability Quote

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Garage Insurance Quote

One Simple Form-takes only 2-3 Minutes!

guaranteed response within 48 business hours!!

Don't want to fill out this form, well then call us now at 561-732-9305 or 1-800-397-8780

or click here and we will contact you!

Company Name
Your Name
Title
Type of Company
Mailing Address City, ST Zip	, ,

County
E-mail
Phone
Fax
Company Website
How Did you hear about us?	If referral If referral please provide name we send like to reward anyone who refers us clients
How would you like us to send you the quote?
Why Do you want to leave your current insurance company?

What Does your Business Do?
Federal Employer Identification Number
Years in Business
Current Ins Carrier	2007-Insurance Company Name Policy Number Expiration Date How many years have you been with them?
Do you sub-contract any work out to others? How Much %?
Years Experience in this type of business
Sales or Receipts Annually)
Do you own any other company?	If yes please describe Below

Garage Liability Coverage

Liability Limit

Garage Keepers Coverage Limit

Amount of Employees (Full) (Part-Time)

Payroll without owners

Owner's Payroll

Please list all locations/amount of cars in lot/what kind of lot protection do you use

Location #1

Location #2

Liquor Liability (Y/N)

If yes, we will either fax you or email you the supplemental application shortly.

Employers Professional Liability (Y/N)

If yes, we will either fax you or email you the supplemental application shortly.

Any Additional Insureds (Y/N)

If yes please list them and relationship

Square Footage you Occupy

Do you Tow?

Are Firearms kept on premises

Do you leave keys in vehicles

Do you have guard dogs

If valet what kind of parking ticket do you use?

If valet do you do special event parking?

If valet do you park any cars in parking garages?

Any Garage Liability Claims in last 5 years? (Y/N)

Date of Loss

If Yes Please describe Below

Umbrella Policy

Umbrella Liability Limit

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

YES

Agent Use Only

Comments/Questions

One Simple Form-takes only 2-3 Minutes!

guaranteed response within 48 business hours!!

Don't want to fill out this form, well then call us now at 561-732-9305 or 1-800-397-8780

or click here and we will contact you!

| About Us | Privacy Policies | 511 E Ocean Avenue Boynton Beach, FL 33435 Phone:561-732-9305 Fax:561-364-9848 email: info@oyerinsurance.com

Driver Information

Accidents, Tickets, Claims for Five (5) Years