AmerInsurance Agency, Inc. – Small Business Insurance

Check all that apply: Embroiderer Screen Printer Specialty Printer

Name of business: *

Description of business: *

Mailing address: *

County or Parish (LA): *

City: *

State: *

Zip: *

Contact person: *

Contact Phone #: *

EIN:

Email address:

Please check one: * Corporation Individual Partnership

Location (if different from above):

Percentage of your business from the Internet:

%

Value of computerized printing machines, embroidery machines and computers: *

$

Value of software and dongles: *

$

Value of business supplies, inventory and non-computerized screen printing machines, if applicable: *

$

Business location owned or rented: * Owned Rented

Construction Type: * Frame Masonry

Square Footage: *

ft²

Year Built: *

Number of Stories: *

Years in Business: *

Multi-Occupied: * Yes No

Value of commercial building (if any to be insured):

$

Is the equipment leased?: * Yes No

Number of lease companies *

Full Time Employees: *

Part Time Employees:

Worker’s Comp Quote: Yes No

Annual payroll: *

$

Estimated sales for next year:

Embroidery: *

$

Screen Printing: *

$

Prior Insurance?: Yes No

Prior Insurance Company *

Expiring Premiums:

$

Any Business Losses?: Yes No

Date of loss:

What happened?

Do you own any other businesses?: * Yes No

Name of other business *

Type of other business:

Are you a National Network of Embroidery Professionals member? Yes No

Member number:

Do you exhibit at fairs or shows? Yes No

About how many per year?

How did you find us? *

Comments or Questions:

Click HERE to print this form, then mail to Pat.

A. J. Amer Agency, Inc.
3700 Embassy Pky. #160
Akron Ohio, 44333
Direct 330 665 7952
Cell 330 730 7822
Office 330 665 9966
Direct FAX 330 247 9400
McKay@AmerInsurance.com

Free quote

IMPORTANT NOTICES: