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Important
Note:
This
document is made available to you for your convenience. This document is
only a quote application and does not pretend to cover any of the of the
terms and exclusions of the policy herein presented. This document is not
your policy and does not modify or extend the cover of this policy. the
insurance company, emitter of the quote/policy is subjected to all the
exclusions and terms of the policy. If there are any discrepancy between
this description and the quote or policy, the quote or policy will
prevail. Remember, this is just a quote form.
Please note that due to technical or natural events beyond our control,
like weather, we may not receive your quote. Please confirm that your
application has been received by calling to our toll free number
1-800-981-6545, Monday trough Friday from 8:30 am to 5:00 PM.
We
are going to process your application in our agency labor hour's: Monday
through Friday from 8:30 AM to 5:00 PM, except holydays.
It’s
our honor to serve you,
Nehemías
Toro Insurance Agent.
Fill in this information
*Required information
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Business Name*
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Physical Address of
Business*
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City and Zip Code of
Business
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Postal Address of
Business
Same as Physical Address ?
Yes
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City and Zip Code of
Postal Address
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Business Description*
Ex. What your
business does?, Field or type of industry
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Contact Person Name*
Person that we
are going to contact to inform about the Quote results
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Phones for contact person
(please provide one at least)
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Main
Phone Number
Please
include extension number if needed
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Area Code:
Number:
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Extension:
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Alternative Phone Number
Please
include extension number if needed
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Area Code:
Number:
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Extension:
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Fax
Number
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Area Code:
Number:
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E-Mail
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Occurrence
What is the
insurance amount per event that you want?
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Aggregate
What is the
yearly total insurance amount per event that you want?
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