STANDARD QUOTE FORM (Acord 125)
Today's Date:
QUOTE TAKER'S NAME:
Email Address:
What is your corporation's name:
What is your DBA:
What is your location address:
City:
State:
Zip Code:
Phone #:
Fax #:
Business type:
What are your hours of operation:
Do you have federal ID number available:
Who is your current Insurance company:
Expiration date:
Current premium: $
Do you have claim or losses:
(Only if this business HAS or HAS HAD insurance, request 3-year loss runs)
Say: "Please fax us your 3-year loss history"
PROPERTY SECTION (Acord 140)
How much coverage do you need for the building:
How much contents coverage do you need:
Do you want Spoilage:
Crime:
What is your building construction type:
What year was it built:
What is the square footage of the building :
Central Station Alarm :
Yes
No
Sprinkler System:
Yes
No
LIABILITY SECTION(Acord 126)
How much liability coverage do you need:
$
What are your annual gross/revenue sales for the year:
$
NOTES
