Pars Insurance - Manufacturer Insurance Quote

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

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Manufacturer Insurance 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

Insured's Name
Phone Number
Fax Number
Email Address
Insured is:
Business Name
Street Address

City

Zip Code

Number of Owners
Number of Partners
Full-Time Employees
Part-Time Employees
Employees Payroll

Estimated Receipts,

Current Year
Next Year
Year Built
Area SqFt.

Loss History

Prior carrier and loss history for the past three years

From Mo. Yr. To Mo. Yr.

Company name

Policy number

Liability losses: Number	Amount
Physical damage losses: Number	Amount

Cancelled or Non-renewed

Reason

Desired Coverages
Garage Liability
Garage Keepers
Personal Property
Loss of Earnings
Open Lot Coverage
Misc. Coverages
Deductible

Brief description of Business Operations:

If you have already been given a quote, entering the figure here may help you get a better deal

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.

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