Contractors Insurance – JJ Insurance Agency

On-Line Contractors Insurance Quote Form

Complete our Minnesota contractors insurance information form and we will be in touch soon.

Contractors Business Information

Enter your full name:

Company name:

Mailing address:

City:

State:

Zip Code:

Email (required):

E-Mail again for accuracy:

Phone:

Fax (optional):

Business Underwriting Information

Type of Contracting Operation:

Please describe exactly what you do:

Business Type (sole proprietorship, corporation, LLC, etc.):

Employer ID# / EIN:

Limit of Liability Coverage Requested?

Currently Insured?

Name of Carrier & how long insured

Prior Claims?

Describe claims in detail:

Years in business:

Years experience in field:

Percentage of work residential:

Percentage of work commercial:

Number of Active Owners:

Number of Employees:

Annual Employee Payroll: $

Annual Gross Sales: $

Do you subcontract work?

(If yes, what percentage of your work is subbed out to others, and what kind of work?)

Comments/Remarks:

Send my insurance quotation via :EmailFaxRegular MailCall 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 to release this information via the method you have chosen, and to release them from 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!