Joseph A. Curley Insurance Agency, Inc.

35 Albion Street, P. O. Box 490
Wakefield, MA 01880

Phone: 781-245-0033     Fax: 781-246-1490

Please be advised that insurance coverage cannot be bound, modified, or terminated by e-mail messages or information provided to us via the web. Any information you submit will be used solely for the purpose of quoting insurance options, and does not in any way constitute an agreement of coverage.

Business Insurance Quote

Company Name:
Address 1: City:
Address 2: State: Zip:
Contact Person: Contact Email:
Office Phone: (with area code)
Ext:
Fax: (with area code)

General Information

  1. Date of desired coverage (DD/MM/YY):

    //

  2. Choose which type of business insurance you would like a quote on:

  3. Full description of your business (This will help us identify your insurance needs)

    Describe your business

    Year business was established:

  4. Is this a seasonal business?

    Yes No

  5. Do you currently have business insurance?

    Yes No

    If yes, company insured with:

  6. Annual gross receipts:

  7. Total annual payroll:

  8. How many employees:

  9. Have you had any insurance claims in the last three years?

    Yes No

    If yes, please describe type(s) of claim(s) and any settlements

  10. Do you own your company's building? (Not applicable if you work out of your home)

    Yes No

    If yes, state building replacement value: $

    If yes, state total building square footage

    Total square feet of area occupied

  11. Deductible (choose one)

  12. Are you the only occupant in your building?

    Yes No

    If no, describe other tenants (i.e. restaurant, retail etc.)

  13. If you are a tenant, are you required to insure the building?

    Yes No

    If yes, state replacement value: $

  14. List building address if different than mailing address above

  15. Age of building

  16. Building Construction

  17. Is building alarmed?

    Yes No

    If yes,

    Burglar Alarm: Yes No

    Smoke Alarm: Yes No

    Central Station: Yes No

  18. Sprinkler system in building?

    Yes No

  19. Business personal property (contents) estimated replacement value

    $

  20. Deductible (choose one)

  21. Commercial general liability (choose one)

  22. If you are a contractor, list value of tools & equipment (exclude vehicles)

    $

  23. How many vehicles are owned by the company?

    Cars Trucks Other

  24. Computers?

    Yes No

    If yes, replacement value: $

  25. Signs?

    Yes No

    If yes, replacement value: $

  26. Questions and/or comments

Requests for insurance information received during regular business hours are processed within 48 hours - often much sooner if possible. Thank you!

Important Note: Quotes will be based on the information provided. It is only a rate calculation and is not binding in any way. A full application must be completed and signed by the named insured.