Please complete our form and one of team members will reach out to you. Business Insurance - Short Form Types of Insurance Needed* General Liability Workers Compensation Property Equipment Business Auto Surety Bond Business Name* Tax ID # (FIEN) Date Business Opened* Type of organzation* Sole Properiter LLC (Limited Liability Compnay) Corporation Not-for_Profit Primary Contact Name* First Last Cell Phone*Email* Business Address (mailing address)* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Description of Business Operations*Please briefly tell us what your company does. Make sure to include any specialty within an industry. For example, if you are a concrete company, please don't simply state "construction" as your industry. We adapt to your specific trade. Number of Employees (counting yourself)* Annual Payroll (excluding what you pay yourself)* Number of Locations*12345I will email Excel Spreadsheet with ListGross Annual Receipts* Claims? Tell us about any claims including when and how much was paid.If you have loss runs please email to reed@reedinsla.com with your Business Name in the Subject FieldOnce you hit submit you will receive an email with instructions on sending supporting documents
