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  • One Stop Shop for all of Your Business Insurance & Commercial Insurance Needs
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    On-Line Businessowners
    Insurance Quote Form
    One Simple Form - takes only 2-3 Minutes!
    Your Personal and Company Data:

    Your Name:
    Your Company's Name:
    Street Address:
    City:
    State: (Must be Florida)
    Zip/Postal:
    E-Mail (REQUIRED):
    E-Mail again for accuracy:
    Phone:
    Fax (optional):
     

    Currently Insured?
    (If yes, list carrier, and # of years
    continuous. If none, type NONE)
     
    Type of Business:
    		 Retail    Wholesale
    Office    Other
     
    List Claims & Amounts Paid
    (If none, type NONE)
     
    Years In Business:
     
    Business type:
    (proprietorship, corporation, etc.)
     
    Describe Business in detail:
    (i.e., Delicatessen and sandwich shop, etc.)
     
     

     
    Underwriting Information:
     
    Describe IN DETAIL,
    Your Business Operations:
     
    Ownership & Payroll Data:
    List Employee's Annual Payroll Here (if none, enter $0): $ Insert # of
    Employees here:
     
    Location & Sales Information:
    Insert Annual Gross Revenues from this operation here: $ Square Footage of office or business location:
     
    Type of Building (wood frame, concrete, etc.): Number of Stories:
     
    Are there other business/residences in this building (describe)?: Describe safety features (alarm, sprinklers, fire protection, etc):
     
    Coverage Desired: (Check One Please)
    The Coverage I Am Looking For:

    Liability Only
    Liability & Business Contents
    Liability, Building & Contents Coverage
    A Package Policy Including the Above,
            Plus Miscellaneous Coverages
    NOTE: Don't worry if you are not exactly sure about coverage type... we will suggest the best coverage for you - just try to tell us what you are looking for! (If we need more info. we will let you know.)
     
    Liability Coverage:
    ($300,000, $500,000, $1 Million, etc.)     		$
     
    Business Contents Coverage:
    (The amount of your personal business property)     		$
     
    Building Coverage:
    (The amount of building coverage if you own your bldg.)     		$
     
    Miscellaneous Coverage:
    (List any special coverage peculiar to your business, such as Garagekeepers Legal, Loss of Earnings, Valuable Papers, etc.)     		$
     
    Other Coverages You Would Like Information On: Commercial Vehicle
    Bonds, License/Performance
    Workers Compensation
    Builders Risk Insurance Commercial Umbrella
     
     
    Send my quotation via: E-Mail Fax
    Regular Mail
    Please Call by Phone!

     
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    Tampa Commercial Insurance (An Affiliate of Insurance Office of America)
    4915 West Cypress Street | Tampa, FL 33607 | Phone: 813-358-4330 | Fax: 813-637-8484
    Email: paul.allard@ioausa.com | Florida Insurance License #: W516422