Pars Insurance - Commercial Liability Quote

Pars Insurance Agency - The Agency You Trust (800) 779-7277

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Commercial Liability Quote

Please complete the following general questionnaire. Our professional, courteous staff will contact you regarding your quote, or call us at (800) 779-PARS

Your Personal Data

Your Name:
Business Name:
Property Address:
City:
State:	CALIFORNIA
Zip:
E-Mail (REQUIRED):
Phone:
Fax (optional):

Underwriting Information

Date Coverage Needed:

Prior Carrier:

Describe Business:

Gross Annual Receipts:	$

Gross Annual Payroll:	$

Square Footage of Your Business Location:	$

Number of Employees:

Tell us what kind of commercial coverage you are looking for, and why:


Prior Claims?	Yes No
Describe claims in detail:

Limits & Coverages:
Liability Limits:	$100,000 $300,000 $500,000 $1 Million

Business Contents Needed? If so, list type and amount:


Comments/Remarks:


Send my quotation via:		E-Mail Fax Regular Mail Call me by Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency release this information via the method you have chosen, and to release us any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me the Quote NOW!

Our courteous and experienced staff will be in touch with you shortly.

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