Commercial Liability Quote

Select the agent you have been working with:

Business Name:

Mailing
Address:

City

State

Zip

Physical
Address:

City

State

Zip

Contact Name

Telephone

Fax

Email

Best time to call:

Type of Business:

Detailed Description of Business including experience.

Are all owners active in the business?

Number of Owners:

Estimated Annual Payroll excluding owners:

Any leased or subcontracted payroll?

Do subs carry their own insurance?

Certificates kept on file?

Gross Receipts (If multiple lines of business, each line.)

Any claims in the past 3 years?

Please send me more information on the following:

** In order to provide an accurate quote, Paragon Insurance may require certain consumer reports.  By clicking the submit button, you authorize an agent of Paragon Insurance Agencies, Inc. to acquire any necessary information including, but not limited to C.L.U.E, MVR, UDD and credit reports.