Keltner Insurance Inc
Your Local Independent Insurance Agency
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Business Owners Insurance Quote
For Help Call 901-797-8665
Fields marked (
*
) are mandatory.
Owner Name
*
Proposed Effective Date
Type of entity
*
Please select
Corporation
LCC
Partnership
Sole Proprietorship
Other
Name of the Company
*
DBA
Address
*
Sqft of Building
Alarm
Yes
No
EIN#
Phone Number
*
Email
*
Business Description
Years in business
Years’ experience
Gross Annual Sales
How many employees
Currently insured?
Yes
No
Any Losses in the last 5 years?
Yes
No
General Liability Limits being requested:
$1,000,000/$2,000,000
$2,000,000/$4,000,000
$5,000,000/$10,000,000
$20,000,000 or higher
Business Personal Property Limit
Building coverage Limit
Deductibles