DG&M Insurance Agency Inc. : Commercial Insurance Quote Request

skip navigation

Insurance is our business. Service is our Policy.

General Information

First Name:
Middle Initial:
Last Name:
Address:
City:
State:	ZIP:
Phone:	Fax:
E-mail:

Business Address

Business Name:
Business Address:
Mailing Address:
City:
State:	ZIP:

Insurance Information

Current Insurance Company:
Type of Business:
Federal Identification Number:
Nature of Business:
Effective Date:	(mm/dd/yyyy)
Estimated Annual Payroll (excluding owners):	$
Owners Payroll:	$
Estimated Annual Gross Sales:	$
Number of Employees:
Building Value:	$
Business Personal Property Value:	$
Tool & Equipment:	$

To ensure you receive the best possible premium, please check all that apply: Dead Bolt LocksFire Extinguisher Smoke DetectorsCentral Station Fire Alarm Local Station Fire AlarmCentral Station Burglar Alarm Local Station Burglar AlarmSprinkler System