Business Insurance Quotation Form

For a Business Insurance quotation for any state in New England, please fill out the following form and click the submit button. An agent will contact you to review a personalized quotation within 24 hours. Thank you for your quotation request. Questions? Please contact us.

Name:

Address (city, state, zip code):

E-mail:

Telephone:

Fax:

Best time to call:

Type of business:

Other:

Number of employees:

Full-time Part-time Annual payroll

How long in business:

years

Approximate annual sales:

Please provide a brief description of your business and clientele:

Coverages:

Commercial Auto	General Liability
Commercial Property	Business Personal Property
Computer Coverage	Umbrella
Workers' Compensation	Other

Comments and additional pertinent information:

Submitting an insurance quotation request to Ellis Insurance Agency does not constitute a binding confirmation of new or altered insurance coverage. Verbal or written confirmation must be obtained from Ellis Insurance Agency to confirm binding or altering coverage.