George Papazoglou
Phone: 734-637-0666
Fax: 866-597-4818
george@miinsurancebrokers.com
www.miinsurancebrokers.com
MI MI Insurance Brokers
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Business Quote Form

 
Name of insured & DBA if applicable?
Description/Type of business?
Type of Entity (LLC, C, S, Individual)?
Tax ID #?
Business address?
Mailing address?
How many years in business?
How many full time/part time employees:
Estimated annual sales/food/liquor?
Estimated payroll?
How much building coverage?
How much improvements and betterment coverage?
How much business property coverage?
Year built?
Sq. footage/how many stories?
Construction type (Joisted/Masonry, Non-Combustible, etc):
Sprinkled?
Local or Central alarm?
Days and hours of operations?
Type of Roof / Furnace/ Electrical/Plumbing updates? What year?
Any claims in past 3 years?
When does your current policy expire?
Current premium?
Current carrier/how long?
Email address?*
Telephone#?*
Comments/Additional Info:*
* For an accurate quote all questions/Fields
must be answered.
 
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