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Commercial Building Property Insurance Quote

First & Last Name:  
Location Street Address:  
City, State & Zip:  
E-Mail Address:  
Telephone:  
Fax:  
Business Name:  
Insurance Company Name:  
Policy Exp. Date:  
Any Claims in Last 3 years?  
(if Yes, please describe)
Do you carry work comp for your managers?  

Property Information

Address (if different):  
Year Built:  
Protection Devices:  
Any Updates to Property?  
(if Yes, please describe)
Complete Lender Info.  
ie Escrow Info if new purchase

Building Information

Units:  
How many Stories?:
# of buildings:  
Flood Insurance?  
Electrical Type:  
Construction Type:  
Total Sq. Ft. of building (s):  
Earthquake Insurance?  
Building Value:  
Contents Value:  

How did you hear about us?


Please give a detailed description of you business and operations:
Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.


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© 2010 Tobias Agency, Inc.
702 Commercial, Suite 1B, Emporia, MI 66801
3261 Broad St. Dexter MI 48130
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