Toll Free: 800-967-3535 or 215-355-5996

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SafeGuard Insurance Agency, Inc. - 201 Bustleton Pike - Feasterville, Pennsylvania 19053
Phone: (215) 355-5996 - Fax: (215) 355-4598 - E-mail: safeguard@safeguard-insurance.com | Hours of Operation: Monday - Thursday: 9:00am - 7:00pm & Friday 'til 5:00pm

© SafeGuard Insurance Agency, Inc.  All rights reserved

Business Insurance Quote Request Form

Fill out the form below and click "Submit" to receive your quote.

Contact Information

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information about you except when we have your permission.

First Name
Last Name
Home Phone
Business Phone
Cell Phone
E-Mail Address
Business Name
Years of Experience in the Industry
Address Line 2
Address Line 1
Address Line 1
Address Line 2
Zip Code
State
City
Legal Entity/Status
SIC Code
Brief Business Description:
Number of Years in Business
Hours of Operation
Desired Effective Date of Coverage
Zip Code
State
City
Number of Full-Time Employees
Number of Part-Time Employees
Subcontractors used
Gross Annual Payroll
Gross Annual Revenue
General Liability
Desired General Liability Limits
Business Owners Policy
Commercial
Workers Comp
Other
Replace an existing policy?
Current Insurance Company
Current Annual Premium
Number of years continuously insured
Number of claims in the past 3 years
Bonds
Errors and Omissions
Non-Owned Auto
Directors and Officers
Business Interruption
Commercial Umbrella
Rental Reimbursement
Employment Practices Liability
Medical
Garaging Street Address
Garaging Suite or Unit #
City
State
Zip Code
Number of Deliveries per Day
Maximum Distance for Deliveries or Worksite
Desired Commercial Auto Liability Limit
Desired Uninsured / Underinsured Motorist Limit
Number of Vehicles
Desired Deductible
Number of Drivers
Date of Last Update
Fire Alarm Type
Burglar Alarm Type
Construction Type
Number of Stories
Basement
Total Sq. Ft. of Building
Total Sq. Ft. occupied by Business
Physical Building Coverage Limit
Desired Deductible Amount
Additional Properties to Insure
Year Building Built
VIN - Vehicle 1
VIN - Vehicle 2
Model
Make
Year
VIN - Vehicle 3
Model
Make
Year
VIN - Vehicle 4
Model
Make
Year
VIN - Vehicle 5
Model
Make
Year
VIN - Vehicle 6
Model
Make
Year
Model
Make
Year
Year
Make
Model
VIN - Vehicle 7
More than 7 vehicles?

Insurance Coverage Requested

Business Details

Business Information

Current Insurance Coverage Information

Additional Details

Information needed for Commercial Auto Coverage

Information needed for Business Owners Policy

Click here to receive your quote for the best coverage at the lowest rate.

Commercial Auto Coverage - Vehicles

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