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Welcome to Boardwalk Insurance Group

Umbrella/Excess Quote

Request an Umbrella/Excess Quote

General Information

Company/Business Name
*
Business Address 2
State
Country
United States
Phone
Business Address 1
City
Zip Code
Fax (Optional)

Contact Person Information

First Name
*
Day Phone
Best Time to call
(HH:MM)
Last Name
Night Phone
E-mail Address
*

Please Tell Us About Your Business

Number of Full Time Employees
Number of Years in Business
Type of Business
Cost of Any Sub Contracted Work ($)
Number of Part Time Employees
Number of Business Locations
Annual Gross Sales (Before Tax) ($)
Please give a brief description of your business & clientele

Location 1 Information

Address 1
City
Zip Code
% Occupied
Contents ($)
Construction Type
Area (Sq. Feet)
Sprinklers
Address 2
State
Country
United States
Year Built In
Building Value ($)
Type of Ownership
Number of Basements
Burglar Alarm

Location 2 Information

Address 1
City
Zip Code
% Occupied
Contents ($)
Construction Type
Area (Sq. Feet)
Sprinklers
Address 2
State
Country
United States
Year Built In
Building Value ($)
Type of Ownership
Number of Basements
Burglar Alarm

Current Insurance Information

Insurance Company Name
Premium Amount ($)
Same Company Policy Since?
Policy Expiry Date (MM/DD/YYYY)
Any Losses In Last 3 Years?

Please Provide An Approximate Amount For The Type Of Coverage You Want

Choose The Type of Coverage You Are Looking For




Any additional comments or information that might be helpful in your Business Owners insurance quote
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.)

Disclaimer

No coverage Of any kind is bound or implied by submitting information via this online form.
  • We will only use information provided to assist in obtaining appropriate insurance quotes and coverage.
  • We will not distribute information to other parties other than for insurance underwriting purposes.
  • 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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