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Commercial Property / Landlord's
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!

Your Name:
Business Name:
Property Address:
State: (Must be New York)
(again for accuracy):
Fax (optional):
Dwelling Information
Type of Coverage: Commercial Property
Landlord's Insurance
Year Building Built:
Building Square footage:
Occupancy: Owner Tenant
Occupancy Type:
(describe entities & and number of units, such as "4 unit apartment" or "2 offices and barber shop", etc.)
Type foundation: Slab
Crawlspace over slab
Pier & Post
Other (list in remarks)
Type finished basement, if any: None Full
25% 50% 75%
Type Roof: Shingle Wood Shake
Tar/Gravel Spanish Tile Metal Other
Type of Siding Brick   Vinyl
Wood   Aluminum
Number of stories: One Two
Three 4 or more
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
Currently Insured? Yes No
Name of Carrier & how long insured?
Prior Claims? Yes No
Describe claims in detail:
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)

Building Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
Other Coverage/Remarks
(describe any extra coverages needed such as business interruption, robbery, computers, etc.):
Send my quotation via: E-Mail Fax
Regular Mail
Call Me by Phone

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