Nonprofit Florida Insurance Quote

Business Information

Business name ✶

Street address ✶

City ✶

State ✶

Zip ✶

Years in business ✶

Legal entity ✶

Annual revenue ✶

# of owners/partners ✶

# of full-time employees ✶

# of part-time employees ✶

# of sub-contractors ✶

Description of operations ✶

Annual payroll ✶

Are you currently insured? ✶

Yes No

Name of current insurance company ✶

Current expiration date ✶

Any claims in the past 5 years? ✶

Yes No

If yes, please provide loss runs from the current insurance company for the last 5 years, and email them to membersinsurancecentercommercial [at] floridamic [dot] org

FEIN

Limits of Liability Desired ✶

Any of the following in the last 10 years? ✶

Bankruptcy

Repossession

Felony Conviction

None of the above

Contact Information

First name ✶

Last name ✶

Phone number ✶

Email ✶

Title ✶

Date of birth ✶

Co-Owner Name

Co-Owner Relationship

Co-Owner Date of Birth

Coverage Information

Currently Insured? ✶

Yes No

Please email your current policy to us at miccommercial [at] floridamic [dot] org

Comments

Binding Agreement

I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email. ✶

Will be sent securely Your request will be sent securely over an SSL-encrypted connection

We respect your privacy. Your information will be sent securely and handled with care. View our privacy policy.

Nonprofit Insurance

Members Insurance Center

Insurance Quote Request

Business Information

Contact Information

Property and Casualty Insurance

Coverage Information

Comments

Binding Agreement

About Us

Recent Articles

Quick Links

Contact Us