General Liability Insurance – JJ Insurance Agency

On-Line General Liability Insurance Quote Form

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

Business Information

Enter your full name:

Company name:

Street address:

City:

State:

Zip Code:

Email (required):

E-Mail again for accuracy:

Phone:

Fax (optional):

Business Underwriting Information

Date Coverage Needed:

Prior Carrier:

Describe Business:

Gross Annual Receipts:

Gross Annual Payroll:

Square Footage of Your Business Location:

Number of Employees:

Tell us what kind of commercial coverage you are looking for, and why:

Prior Claims?

Describe claims in detail:

Limit of Liability Coverage Requested?

Business Contents Needed? If so, list type and amount:

Comments/Remarks:

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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.

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