To begin an insurance quote, please provide us with the following information about your business. We'll get back to you right away regarding any additional information we'll need in order to provide you with an accurate and competitive quote.

Required fields are marked with: *

Business information

Business name *

Address

Years in business

Legal entity

C CorporationLLCOtherPartnershipSole proprietorshipS Corporation

Annual revenue

$100,000 - $500,000$1,000,000 - $5,000,000$500,000 - $1,000,000$5,000,000 - $10,000,000Over $10,000,000Under $100,000

# of owners/partners

# of full-time employees

# of part-time employees

# of sub-contractors

Description of operations

Annual payroll

$

Contact information

Your name *

Phone number *

Email *

Title

Property and casualty insurance

General liability

Commercial auto

Commercial property

Professional liability (E&O)

Directors and officers liability

Business owners package policy (BOP)

Workers compensation

Commercial crime

Employee benefits

Group health insurance

Group life insurance

Group disability insurance

401K / retirement plans

Supplemental plans / AFLAC

Key man life insurance

Key man disability insurance

Deferred compensation

Comments

Comments

Binding Agreement

I understand that by submitting this request I cannot bind or change insurance coverage and that any policy changes are effective only when I have received a written confirmation from Amity Insurance & Financial Services, LLC.

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