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Property and Casualty
Wholesaler since 1965
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Step One: Complete Form
Step Two: Review and Submit
Step Three: Finish
Welcome to Contractors EZ-App 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.
 
Producer Name:
 
Producer Code:
Producer Phone Number:
Producer Fax Number:
E-mail Address:
 
Agency Contact Name:
Insured Name:
Insured's Address:
Effective Date:
     
 
Has the insured had any claims in the last 3 years? 
   
Select the Type of Business:
Applicant's Contractors License #:
 
Type of Contractor
(GC, Electrician, Roofer, etc.):
 
Enter number of Owners/Partners:
 
Enter the Total Payroll for the Owners:
 
Enter Direct employee payroll:
 
Enter uninsured subcontractor payroll:
 
Enter total insured subcontractor cost:
 
Percentage of Residential Work:
 
Percentage of Commercial Work:
 
Estimated number of new home startups for policy period:
 
Annual estimated gross receipts:
 
Select liability limit:
 
Had prior insurance:
 
Prior Carrier:
 
Target Premium:
 
Optional scheduled inland marine indication:
Enter scheduled equipment value
 > $500 per Item:
 
 
Maximum $100,000 per item not to exceed $300,000 total insurance value. Note: ACV basis only. $1,000 deductible. Credit available.
    (You will get a summary page to review before submitting)