Skip to content
Premium-UIC
Home
Services
My Policy
Contact Us
Menu
Home
Services
My Policy
Contact Us
Get a Quote
+1 (802) 500 3270
832 626 0727
Quote In Progress
TYPE OF WORK YOU DO
STATE BUSINESS REGISTERED IN
LEGAL NAME OF THE BUSINESS
(will show on your policy)
BUSINESS REGISTERED AS
Sole Proprietorship
Individual
Partnership
LLC
Corporation
Other
Not Registered
EMAIL ADDRESS
(We don't send SPAM, we don't send marketing information)
General Liability
(Liability protection for bodily injury and property damage)
Business Owners Policy (BOP)
(Combine general liability and business personal property)
Workers Comp
(Protection for injuries or illness arising from their work)
Professional Liability (E&O)
(Protection for claims of financial loss caused by negligence in your professional services)
Business Auto
(Protection for business vehicles)
Surety Bond
(Financial guarantee)
Excess Liability
(Also known as umbrella liability)
NUMBER OF OWNERS / PARTNERS
YEARS UNDER CURRENT BUSINESS NAME
YEARS OF INDUSTRY EXPERIENCE
EXPECTED ANNUAL SALES
(will show on your policy)
NUMBER OF EMPLOYEES
(will show on your policy)
EMPLOYEE YEARLY PAYROLL - IF ANY * People who work for you on on W2
(will show on your policy)
DO YOU HIRE SUB CONTRACTORS OR DAY LABORERS
(will show on your policy)
Yes
No
BUSINESS LOCATION
Home Office
Commercial Office
HAVE YOU HAD BUSINESS INSURANCE CLAIMS IN LAST 5 YEARS*
Yes
No
WHEN DO YOU WANT INSURANCE TO START
Today
ASAP
In A Week
In A Month
Later This Year
Not Sure
BRIEF DESCRIPTION OF WORK YOU DO
WORKERS COMPENATION LIMITS*
FIRST NAME (BUSINESS OWNER)
LAST NAME (BUSINESS OWNER)
BUSINESS ADDRESS (NO PO BOX)
CITY
STATE
ZIP CODE
PRIMARY PHONE NUMBER
ALT PHONE NUMBER
EMAIL ADDRESS
COMMENTS
Get Quote
Scroll to Top
