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Phone: 313 543 2234   (09:00 - 18:00)
Email: info@miainsurancellc.com
Get a Quote
 
Request a Business Quote
General Information
Company/Business Name: *
Business Address:
   
City: State:
Zip/Postal Code: Country: United States
Phone: * Fax:
E-mail Address:*
       
Contact Person Information
Full Name: Title:
       
Please Tell Us About Your Business
Number of Full Time Employees: Number of Part Time Employees:
Number of Years in Business: Number of Business Locations:
Type of Business:
Annual Gross Sales (Before Tax) ($): Cost of Any Sub Contracted Work ($):
Please give a brief description of your business & clientele:
 
Location 1 Information :
Address:
   
City: State:
Zip: Country: United States
Year Built In: Occupied:
Building Value ($): Contents ($):
Type of Ownership:
Construction Type:
Number of Basements: Area (Sq. Feet):
Burglar Alarm:
 
Sprinklers:
 
 
Location 2 Information
Address:
   
City: State:
Zip: Country: United States
Year Built In: Occupied:
Building Value ($): Contents ($):
Type of Ownership:
Construction Type:
Number of Basements: Area (Sq. Feet):
Burglar Alarm:
Sprinklers:
 
Current Insurance Information
Insurance Company Name:
Policy Expiry Date (mm/dd/yyyy): Premium Amount ($):
Any Losses In Last 3 Years?
Same Company Policy Since?
 
Please Provide An Approximate Amount For The Type Of Coverage You Want
Choose The Type of Coverage You Are Looking For:
Liability Coverage (Ex. $300,000, $500,000, $1 Million, etc.): Building Coverage ($):
Business Content Coverage ($): Miscellaneous Coverage ($) (All Coverage including Loss of Earnings, Valuable Papers, etc.):
Any additional comments or information that might be helpful in your Business Owners insurance quote:
       
Disclaimer
No coverage of any kind is bound or implied by submitting information via this online form.
  • We may collect personal information about you, including your credit report, insurance credit score, and prior claims or driving record. We may use third parties to collect such information.
  • We will only use information provided to assist in obtaining appropriate insurance quotes and By checking the box below you agree to release us from any liability should this information be accidentally viewed by others.

 

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