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COMMERCIAL INSURANCE
What type of coverage do you need?
Business Owners Policy
Commercial Auto
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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:
PROPERTY INFORMATION:
Year Built:
Construction (frame, brick, stucco, other?)
Square Footage:
Describe Security System (monitored alarm?)
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:
E-Mail
Day Phone
Night Phone
Fax
Regular Mail
Additional Comments:
Corporate Office: 9705 Burnet Rd, Suite 314 | Austin, TX 78758
(512) 339-2900 | Fax: (512) 339-0169
email: aigagent@texas.net
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