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info@allchoiceinsurance.com
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844.540.0463
Commercial Auto Insurance Option
Hidden
LEAD SOURCE
WHAT IS IMPORTANT TO YOU?
(Other Than Price) What Is Most Important When It Comes To Choosing An Insurance Carrier?
*
Claims Service
Financial Rating
Steady Pricing (Limited Price Spikes Up Or Down)
(Other Than Price) What Is Most Important When It Comes To Choosing An Insurance Advisor?
*
An Advisor That Will Educate Me About My Coverages & Offer Advice
Positive Reviews (ex Google Review)
Anywhere Access (Online, Text, Phone, etc)
Access To Multiple Insurance Carriers
Quick Turnaround On Service Requests
INSURED | CONTACT INFORMATION
Business Name
*
Primary Business Contact
*
First
Last
Mailing Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mobile Phone
*
Is It Ok To Text You?
*
Yes
No
Email
*
BUSINESS INFORMATION
Federal ID
*
# Of Full-Time Employees
*
Enter "0" if No Full-Time Employees
# Of Part-Time Employees
*
Enter "0" if No Part-Time Employees
Annual Revenue (Gross Sales)
*
Annual Payroll
*
0 Employees = $0 Payroll
Nature Of Business
*
Apartments
Condo / Homeowner Association
Contractor (Construction)
Landlord (Rental Unit Owner)
Lessors Risk (Commercial Property Owner)
Manufacturing
Office
Professional
Restaurant
Retail
Service
Wholesale
Date Business Started
*
Description Of Primary Operations
*
INSURANCE HISTORY
Commercial Umbrella - 5 Year Loss History
*
No Losses
Losses
Has Your Commercial Umbrella Ever Been Cancelled
*
No
Yes - Non-Payment
Yes - Claims
Yes - Underwriting Reasons
Yes - Other
Current Coverage
*
Yes
No
Current Carrier
Expiration Date
MM slash DD slash YYYY
UNDERLYING EXPOSURE INFORMATION
Underlying Policy Information
*
Business Owner's / General Liability
Business Auto
Workers Compensation
Professional Liability
Check ALL Insurance Types That You Have Current Policies For
Business Owner's / General Liability Carrier
Business Owner's / General Liability Expiration Date
MM slash DD slash YYYY
Business Owner's / General Liability Annual Premium
Annual Premium Is ONE Of The Rating Variables
Business Owner's / General Liability Policy Limits
$1,000,000 Occ / $2,000,000 Agg
$500,000 Occ / $1,000,000 Agg
$300,000 Occ / $600,000 Agg
Business Owner's / General Liability File Upload
Drop files here or
Select files
Max. file size: 50 MB.
Upload Any Current Declaration Pages Or Other Documents You May Have
Business Auto Insurance Carrier
Business Auto Insurance Expiration Date
MM slash DD slash YYYY
Business Auto Insurance Annual Premium
Annual Premium Is ONE Of The Rating Variables
Business Auto Insurance Policy Limits
$1,000,000 Combined Single Limit
$750,000 Combined Single Limit
$500,000 Combined Single Limit
$300,000 Combined Single Limit
Type Of Vehicles Owner And/Or Leased
Commercial Private Passenger (cars)
Light Trucks (0-10,000 lbs)
Medium Trucks (10,001 - 21,000 lbs)
Heavy Trucks (21,001 - 45,000 lbs)
Extra Heavy Trucks (45,001 +)
Trailers
Public Vehicles
Number of Private Passenger
Number of Light Trucks
Number of Medium Trucks
Number of Heavy Trucks
Number of Extra Heavy Trucks
Number of Trailers
Number of Public Vehicles
Business Auto Insurance File Upload
Drop files here or
Select files
Max. file size: 50 MB.
Upload Any Current Declaration Pages Or Other Documents You May Have
Workers Compensation Carrier
Workers Compensation Expiration Date
MM slash DD slash YYYY
Workers Compensation Annual Premium
Annual Premium Is ONE Of The Rating Variables
Workers Compensation Policy Limits
$1,000,000 | $1,000,000 | $1,000,000
$500,000 | $500,000 | $500,000
$100,000 | $100,000 | $500,000
Workers Compensation File Upload
Drop files here or
Select files
Max. file size: 50 MB.
Upload Any Current Declaration Pages Or Other Documents You May Have
Professional Liability Carrier
Professional Liability Expiration Date
MM slash DD slash YYYY
Professional Liability Annual Premium
Annual Premium Is ONE Of The Rating Variables
Professional Liability Policy Limits
$1,000,000
$500,000
Professional Liability File Upload
Drop files here or
Select files
Max. file size: 50 MB.
Upload Any Current Declaration Pages Or Other Documents You May Have
Disclosure Statement
By submitting this request, you agree to receive communication(s) from ALLCHOICE, Inc. via Phone, Text, SMS, Email, Voicemail, or any other form of communication that may be deemed as beneficial.
We use the information you provide as well as information from other sources, such as your driving record, claims, and credit histories, to calculate a price for your insurance.
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Personal Insurance
Commercial Insurance