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Commercial Quote

We look forward to providing quotes with the best company, coverage and premium!
If you like, you can also call us to request a quote over the phone.

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Commercial Insurance Quote Request

No Coverage is bound until you are contacted by one of our representatives
Contact Info
*
First Name Last Name
Business Name*
Address*
Street Address Address Line 2 City State ZIP Code
Work Phone*
Cell Phone*
Your Web site (if applicable)
Email*
It is OK to save my email address for the purpose of current and future correspondence:*
- Yes
- No
How did you hear about Walker Insurance?

Business Activities
Type of organization:*
Federal Tax ID Number (Or SS# if no tax ID):
How many owners, partners, or officers?*
How many employees, excluding owners, partners or officers?*
Are you just starting this business?*
- Yes
- No
In what year did you start this business?*
How many years experience in your industry?*
Last year's payroll (excluding owners):*
This year's projected payroll (excluding owners):*
Estimated annual contract labor cost:*
Last year's gross sales:*
Describe your normal business activities:*
This year's projected sales:*
Do you currently hold a commercial insurance policy of any kind?*
- Yes
- No
Your current commercial insurance company(s):
Your current policy expiration date(s):
MM slash DD slash YYYY
The type(s) of coverage you currently carry:
Have you had losses or claims in the past 5 years?
- Yes
- No
If yes, please give description, date and amount paid for each:
What approx. amount of square footage do you occupy for business purposes?*
Do you office in:
If you office in a commercial building, do you rent or own the building?
What is the approximate age of the building?*
What is the predominant exterior building material of the building?*
Do you use a monitored alarm system in your place of business?*
- Yes
- No

Please indicate the desired coverage you want quoted
- General Liability
- Excess Liability
- Worker's Comp
- Builder's Risk
- Professional E & O
- Business Life Insurance
- Commercial Auto
- Property
- Equipment
- Directors and Officers Liability
- Group Health
- Individual Health
- Other
If general liability was selected, how much?
If excess liability was selected, how much?
If other was selected, please describe
Desired effective date*
MM slash DD slash YYYY
Are you looking for coverage to satisfy a client contract requirement?*
- Yes
- No
Any questions, comments, or concerns you'd like to share at this time?

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VGW Insurance
Direct: 972-727-8949
Toll Free: 800-774-2004
[email protected]

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