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Request Business Insurance Quote

For the fastest and most accurate insurance quote, please provide as much information possible in the form below. This information will be kept confidential and will be used for quote purposes only.

Please note that no coverages can be changed, altered or bound through this form.

Business Information
Business Name:
Address:
City:

 
State:
Zip:
Contact Name:
Phone:
Fax:
Email:
Business Type:
Corporation
Partnership
Individual  
Business Description:
Years in Business:
Present Insurance Company:
(not agency)
Policy Expiration Date:
Expiring Premiums Last 3 Years:



Property Information
Location Address:
City:
State:

 
Zip:
Type of Construction:
Frame
Masonry (block wall-wood roof)
Non-combustible (block wall-metal roof)
Sprinklered:
Yes   No
Alarm:
Burglar Fire
Type of Alarm:
Local
Central
None
Occupied By:
Owner  Tenant
Glass Linear Feet:
Sign Value:

 
Building Value:
Age of Building:
Deductible:
Business Contents:
Tenant Improvements:
Computer Hardware:
Computer Software:

 

 

Liability
Liability Limit:
$500,000   $1,000,000
Number of Employees:
Full Time        Part Time
Annual Payroll Employees:
Annual Payroll Owners:
Gross Sales:
Non-Food:
Food:
Liquor:
Number of Claims:
Payout Amount:
 

Automobile
Liability Limit: $500,000     $1,000,000
Year
 
Make
 
Model Comprehensive
Deductible
Collission
Deductible
Cost New GVW
Number of Claims:  Payout Amount:  

Workers Compensation
Class Code Number of Employees Payroll
Number of Claims: Payout Amount:

 

 

Kleeber Insurance Services, established in 1851, is a subsidiary of Kinderhook Bank Corporation, the holding company for Kinderhook Bank.

*Insurance products are not a deposit or an obligation of, or guaranteed by, Kinderhook Bank. Not FDIC insured.