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COMMERCIAL INSURANCE TEXAS
What type of coverage do you need?
 Business Owners Policy
 Commercial Auto CLICK HERE FOR QUOTE!
 Property & Contents
 Workers Comp Texas
 General Liability
 Garage Liability
 Heavy Truck
 Other
Other? Please Explain:


Contact Name:


Name of Business:


Legal Entity: (for example, sole proprietor, corporation, partnership etc.)


Description of Business:


Effective Date Desired:
Annual Sales $
Annual Payroll $
# of employees:
Years in Business:

AMOUNT OF LIABILITY COVERAGE:
 $1 million Liability
 $2 million Liability
 $3 million Liability

AMOUNT OF PROPERTY COVERAGE:

Deductible Preferred:
 $500 deductible
 $1,000 deductible
 $5,000 deductible
 1% deductible
 2% deductible
 5% deductible

List all Prior Losses in 5 years:


PROPERTY INFORMATION:
Year Built:
Age of Roof:
Roof Construction:
Construction (frame, brick, stucco, other?)
Square Footage:
List any updates and year they were done for plumbing, electrical and/or ac:
Describe Security System (monitored alarm?)
Does your building have a sprinker system? (Yes or No)   
Do you have current insurance and with who:
List Neighbors on all sides of your property?

Street Address:

City: - State: - Zip Code: - County:

Day Phone # (including area code):

Night Phone #(including area code):

Best time to Call: AM PM

Fax # (including area code):

Email:


Preferred Method Of Contact:


Additional Comments:
Corporate Office: 9705 Burnet Rd, Suite 314 | Austin, TX 78758
(512) 339-2900 | Fax: (512) 339-0169
email: aig@texas.net
 Directions/Map
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