Office Hours:
6:00 AM to 6:00 PM (PST)
License# 0L09546
....
Login
Site Map
|
Contact
HOME
DASHBOARD-DOCUMENTS
APPLICATIONS
COMMERCIAL
PERSONAL
EMAIL
ABOUT US
Sign-in
Password Recovery
Register
New Producer
New Producer DB
Self-Serve
Self-Serve
Directory
Contact Us
Markets
Privacy Policy
Terms of Use
Careers
Step One:
Complete Form
Step Two:
Review and Submit
Step Three:
Finish
Welcome to
E-Z Quote
from A&M.
For fast service on your commercial accounts complete the form below and hit the "Step Two" button. Your submission will be electronically delivered to the next available Commercial Lines Underwriter.
Coverage Requested:
Package
Monoline Liability
Monoline Property
Coverage Requested is required!
Applicant Name:
Applicant's Name is required!
Applicant Website Address:
Applicant's URL is required!
Location address:
Address is required!
City:
City is required!
State:
State is required!
Zip Code:
Zip Code is required!
Applicant's Primary Telephone #
Phone number is required!
Description of Risk:
Description of Risk is required!
Prior Losses?
Yes
No
Prior Losses is required!
If yes, include 5 years hard copy loss runs with submission.
Has applicant had any policies or coverage’s cancelled or non-renewed in the past three years?
Yes
No
N/A
Has applicant had prior Bankruptcy in the past 7 years?
Yes
No
N/A
Have any crimes occurred or been attempted on the premises within the last 3 years?
Yes
No
N/A
Expiring Carrier:
Expiring Carrier is required!
Willing to Renew?:
Yes
No
N/A
Renewal Quote:
$
If no, why?:
Target Premium:
$
General Liability
Property
Limits Requested:
$
Payroll:
$
Number of Employees?:
Number of employees is required!
Receipts:
$
Square Footage:
If Apt., # of Units:
Years in Business:
Does the applicant lease Employees to or from other Employers?
Yes
No
N/A
Building:
$
Contents:
$
Loss of Income:
$
Protection Class:
Construction Type:
Square Feet:
Sprinkler?:
Yes
No
N/A
Central Alarm?:
Yes
No
N/A
Year Built:
Is Building 100% on Circuit Breakers?:
Yes
No
Is building 100% on Circuit Breakers is required!
If over 20 years old, provide building updates:
Building Updates / (Year)
Wiring (Yr):
Roof (Yr):
Heating/Air (Yr):
Plumbing (Yr):
What is the quality of the housekeeping?
Does the applicant have emergency lighting?
Yes
No
Does have emergency lighting? - is required!
Is the Applicant:
(a) An owner of any other properties or business operations under this legal entity?
(b) Related to another entity through common ownership?
C) Subsidiary of another entity?
If yes to any of the above please explain.
Comments & other Material Information:
Agency Name
:
Agency Name is required!
Contact Person
:
Contact Person is required!
Phone Number:
Agency Phone Number is required!
Fax Number:
E-mail Address:
Agency Email address is required!
Please enter a valid e-mail address!
(You will get a summary page to review before submitting)