For a competitive quote, please complete the form below and submit, or select from the quotes at right.
Select a Quote Form
auto
homeowners
commercial
Corporation Name
DBA Name
FEIN #
Location Address
Mailing Address
City
State
Zip Code
Contact Name*
Contact Phone*
Email*
Description of Operations
Other
Years of Experience
Prior Insurance coverage
Years Established
Expiration Date
Number of Employees
Coverages
Payroll Total
Claims
Sales Total
Year Built
Owned/Leased?
Owned
Leased
Square Feet
Alarm System
Yes
No
Year Updated
Sprinkler System
Roof Type
Glass/Sign
Construction Type
Misc.
No. of Floors
Building
Liability
Contents
Products
Business Income
Per injury
Fire Legal
Theft Deductible
Medical Pay
Wind Deductible
Deductible
Coverage
Basic
Broad
Special
Value
Replacement Cost
Actual Cash Value
Percent
80%
90%
List other relevant information:
Coverages are subject to policy terms and conditions. Limits, exclusions and deductibles may apply.
Insurance Financial Center 10300 SW 72 Street • Suite 232 • Miami, Florida 33173 Phone 305-596-5840 Fax 305-596-5828
www.ifcinsurance.com • Copyright 2003 Dynamic Design Online, Inc. Website Developed and Maintained by Dynamic Design Online, Inc. • Miami, Florida
