IMPORTANT NOTICE

1. This commercial property insurance quote request applies only to the states of Oregon and Washington. Do not fill out this form if your business property is not located in Oregon or Washington.

2. No insurance will be started by submitting this form. Coverage may be placed in force only after you decide to purchase it from us, and then after you complete and sign the insurance application and pay the initial premium.

3. Submitting the following quote request constitutes your agreement with the above statements. We will contact you within two business days after we receive your request. If you have questions concerning this notice or about the following form, please call us at 503-620-0230 or 1-888-620-0230.

Commercial Property Insurance Quote Request
  1. Your First Name
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  2. Last Name
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  3. Your Business Name
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  4. Phone Number
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  5. Fax Number
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  6. Email Address
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  7. Business Website, if any
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  8. Street Address
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  9. City
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  10. State
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  11. Zip Code
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  12. County
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  13. Building address if different from above
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  14. In the following box, describe what kind of businesses occupy your building and what percentage of the space they occupy.
  15. Building Occupancy
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  16. What percent of building is vacant?
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  17. What is estimated building replacement cost?
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  18. What year was the building built?
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  19. How many floors does the building have?
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  20. What is square footage?
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  21. Distance in feet to nearest fire hydrant
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  22. Distance in miles to nearest fire station
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  23. Describe types of building security alarms and devices.
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  24. Current building condition
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  25. Currently insured?
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  26. If yes, current insurance company
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  27. Is your current insurance being canceled or non-renewed?
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  28. Is contents coverage also needed?
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  29. If 'Yes,' describe the type of contents and amount of coverage wanted.
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  30. Additional information or comments
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  31. Re-type the security field numbers in the box.
  32. Security Field
    Security Field The Security code you typed did not match. Please click "Refresh" and try again.
  33. To keep a copy of this form, please Print before Submitting
  34.   

 

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Questions?

If you have questions concerning this information, please call us at 503-620-0230, or come in.

Llámenos ya al 503-620-0230.