Commerce Group, Inc.

Business Quote

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If you wish to receive an accurate quote, please fill out the form completely. If you prefer you can give us your contact information only, and we will contact you by the next business day.

Name


First Name	Last Name

Business Name

Business Address


Address

Address Line 2

City	State	Zip Code

Mailing Address (if different from location)


Address

Address Line 2

City	State	Zip Code

Home Phone

Phone Number

Work Phone

Phone Number

Email Address

Business Website

Description of Business

Type of Business Entity

Select one

LLC
Corporation
Partnership
Sole Proprietor

Current Insurance Co.

Renewal Date of Current Insurance

Click in box to select date

How many years in business?

How many employees?

Own or lease the building?

Select one

own
lease

How many business autos?

Claims in the last 5 years?

What is the gross annual revenue?

Type of coverage needed

Select all that apply

* required