Call us: (321) 254 0858
Home
About Us
Services
Free Quote
Claims Reporting Numbers
Claims Tips
Important Links
FAQs
Contact Us
Protecting your
loved ones is that easy

Request a Business Owner's Quote
       
* Mandatory Fields
 
General Information
Company/Business Name:*
Business Address:
City: State:
Zip: Country: United States
Phone: Fax (Optional):
 
Contact Person Information
First Name: *
Last Name:
 
Day Phone: Night Phone:
Best Time To Call (HH:MM):    
E-mail Address: *
 
 
Please Tell Us About Your Business
Number of Full Time Employees: Number of Part Time Employees:
Number of Years in Business: Number of Business Locations:
Type of Business:
Annual Gross Sales (Before Tax) ($): Cost of Any Sub Contracted Work ($):
Please give a brief description of your business & clientele:
 
Location 1 Information
Address:
City: State:
Zip: Country: United States
Year Built In: % Occupied:
Building Value ($): Contents ($):
Type of Ownership:    
Construction Type:
Number of Basements: Area (Sq. Feet):
Burglar Alarm:       Sprinklers:      
 
Location 2 Information
Address:
City: State:
Zip: Country: United States
Year Built In: % Occupied:
Building Value ($): Contents ($):
Type of Ownership:      
Construction Type:
Number of Basements: Area (Sq. Feet):
Burglar Alarm:       Sprinklers:      
 
Current Insurance Information
Insurance Company Name:
Policy Expiry Date (MM/DD/YYYY): Premium Amount ($):
Any Losses In Last 3 Years?       Same Company Policy Since?
 
Please Provide An Approximate Amount For The Type Of Coverage You Want
Choose The Type of Coverage You Are Looking For:
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.):
Any additional comments or information that might be helpful in your Business Owners insurance quote:
 
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.




    		•

    Client Testimonials

    GET A QUOTE

    Click here for Free Quote

    Personal Insurance

    Business Insurance

    Client Services

    Questions? Contact Us today!

    Harbor City Insurance
    Agency Incorporated
    865 Sarno Road
    Melbourne, FL 32935

    Phone: (321) 254 0858
    Fax: (321) 253 9005
    E-mail: harborcityins@cfl.rr.com
    Home
    About Us
    Services
    Free Quote
    Claims Reporting Numbers
    Claims Tips
    FAQs
    Contact Us
      Copyright © 2008 Harbor City Insurance Agency Incorporated. All Rights Reserved. Disclaimer
    		Website Design by New Link RiaEnjolie