WFIG COMMERCIAL INSURANCE QUOTE FORM

Williams Family Insurance and Investment Group Commercial Insurance Request Form

Please thoroughly and honestly answer as many questions as possible. Mark N/A to questions that don’t apply to your insurance situation. For questions that you are unable to answer, schedule a short zoom meeting with a WFIG rep by using this link: https://calendly.com/wfig.

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Step 1 of 4

WFIG Commercial Insurance Request Form – General Information

Name

First Last

Please provide the legal name used on business documents.

Please provide the email you want to use for business communication.

Mobile Number (Text Capable)

Providing a mobile number is considered providing permission to text/

What Type of insurance are you looking for (GL, CP, PL, WC, CA, I Marine, Etc.)?*

GL = General Liability CP = Commercial Property WC = Workers Comp CA = Commercial Auto I Marine = Inland Marine

When will you need insurance?*

Please tell us when you will need insurance

Legal Company Name*

As registered with the state.

Main Contact for Company Insurance?*

First Last

Main Contact Email Address?*

Business email address preferred.

Main Contact Mobile Number?*

Providing this number is considered written permission to phone, text, and leave an automated voicemail.

Main Contact Text Message Number?*

Providing this number is considered written permission to phone, text, and leave an automated voicemail.

Company Address (Headquarters/Registered with the state/primary)?*

Street Address Address Line 2 City State ZIP Code

Please provide the physical address that is registered with the state.

Company Main Phone Number?*

Please provide a text message capable business phone number*

If applicable

Is the business a corporation, LLC, partnership, Sole proprietor, or other?*

Please define other if applicable

What is the primary product or service the business provides?*

The product or service that is identified by SIC Code or that generates the most revenue for the business.

What is the estimated annual business revenue?*

This number helps us provide the correct insurance amount that can protect income and lost revenues.

Williams Family Insurance and Investment Group Commercial Insurance Request Form

WFIG Commercial Insurance Request Form – General Information

Employee Information

Building Property Questions

Commercial Auto Questions

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