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Our Other Insurance Products
 
Click Link for an
On-Line Quote Form

Auto Insurance

Cycle & 4 Wheeler

Boat & Yacht

Homeowners

MobileHome

Group Health Insurance

Health Insurance

Disability Insurance

Business Owners

Contractor Liability

Workers Compensation

Garage & Auto Dealers

Tow-Truck Insurance

Restaurant/Hotel/Motel

Professional Liability

Directors & Officers


Questions? Please
E-mail Us At:
larryb@whitneyharrison.com

   

On-Line Commercial Restaurant
Hotel/Motel Insurance Quote
One Simple Form - takes only 2-3 Minutes!


Your Personal Data

Your Name:
Business Name:
Property Address:
City:
State: MUST be Missouri!
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):
 
Underwriting Information
 
Federal Tax ID#:
(Some carriers use credit history to qualify, this information is REQUIRED)
 
Date Coverage Needed:
 
Prior Carrier:
 
Describe Business:
 
Gross Annual Receipts: $
 
Describe any liquor sales:
 
Describe any live entertainment:
 
Describe food sales:
 
Gross Annual Payroll: $
 
Square Footage of
Your Business Location:
$
 
Type of Buildings
and year of construction:
$
 
If motel or hotel, how many units?
 
What is average occupancy rate?
 
Number of Employees:
 
Tell us what kind of
commercial coverage you
are looking for, and why:
 
Prior Claims? Yes No
Describe claims in detail:
 

Limits & Coverages:
Liability Limits: $100,000    $300,000
$500,000    $1 Million
 
Building Coverage Needed?
If so, list type and amount:
 
Business Contents Needed?
If so, list type and amount:
 
Don't worry if you are not sure of coverage needed or other information. This preliminary form will allow us to approach the proper carriers and we will get other information from you as needed later.
 
Comments/Remarks:
 
Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone


Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency release this information via the method you have chosen, and to release us any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a Quote NOW!


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Whitney Harrison Insurance, Inc. - 2412 S. Franklin Street - Kirksville, MO 63501 - Phone# 660.665.1212 - Fax# 660.665.9444
MO Insurance License #AG93792 - Terms of Use/Privacy Notice - Get Missouri Insurance.com, updated: September 2004.
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