Request for Quote for Business Insurance

Request for Quote for Business Insurance

Here is your opportunity to get a free, no-obligation business insurance quote. Just follow the instructions below and when you have completed the form press the submit button. Your request will be handle by one of our staff members as soon as possible.

Instructions: Please complete as much of the form below as possible. We do not require that you complete all the information below, but please complete as much information as you can for the most accurate quote.

If you prefer, phone our office for a quote at (301) 229-1500

E-Mail

Personal Information
Name
Address
City	State Zip
Email Address	(optional)
Phone
Fax
Contact Me Via:	(please select from list below)
First Choice		Second Choice

Current Business Insurance Information
Current Business Insurance Carrier
Expiration Date

Business Information
Name of Business
Business Address
City	State Zip
Contact Person
Phone
Describe Type of Business
Does your business occupy a building? Yes No If yes, is this building: owned by you rented/leased
Number of Employees	Full Time Part Time
Annual Sales
Annual Payroll
Business Type

Have you submitted any claims in the past five years? Yes No
If so, please describe (include date(s) of loss and amount(s) paid)

Comments / Remarks

LICENSURE NOTICE
Henry A. Latimer & Son, Inc. is licensed to conduct
business in Maryland, Virginia and District of Columbia.
The information on this site is a solicitation to conduct
business only in the aforementioned states of authority.

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