December 6, 2021
Vegreville Insurance Ltd

Business Quote

General Information
Contact Name *
Email *

Business Name
Postal Code
Business Phone
Current Insurance Company
(not agency)
Company Name
Policy Expiration Date
Current Insurance Coverages
Current Coverages Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
Professional Liability
Business Information
How long in Business? (yrs)
Please give a brief description of your business and clientele
Property/Premises Information
Occupancy Status Owner  Tenant
Year Built
% Occupied
Sprinklers Yes  No
Construction Type
Sq. Footage
Estimated Rebuild Cost
Other Property (specify)
Insurance Information
Annual Gross Sales: (before taxes)
Liability Limit Requested $1,000,000
Describe any claims you've had in the past 5 years
Additional Comments
* = Required Field
Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.