Thank you for your interest in receiving a business insurance quote with Redding & Allen Insurance. This form should only take about 5-10 minutes to complete. Don't worry if you don't have everything. You can always click the "Save and continue later" button below. We'll email you a private link to pick up where you left off.

When do you want the policy to start?(Required)

Legal Business Name(Required)

Entity Type(Required)

DBA

Tax ID(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Contact Information

Name(Required)

First Last

Date of Birth(Required)

Email(Required)

Phone(Required)

Can we text you?(Required)

Yes

No

Designated Financial Responsibility for Company?(Required)

Yes

No

What is your role?(Required)

Years of experience in this type of business(Required)

How many years of management experience?(Required)

Other Role(Required)

Is there a Secondary business contact?

No

Yes

Secondary Contact Information

Secondary Contact: Name(Required)

First Last

Secondary Contact: Date of Birth(Required)

Secondary Contact: Email(Required)

Secondary Contact: Phone(Required)

Secondary Contact: Role(Required)

Secondary Contact: Years of experience in this type of business(Required)

Secondary Contact: How many years of management experience?(Required)

Secondary Contact: Other Role(Required)

General Business Information

How many days per week is business open?(Required)

Hours of Operation(Required)

Is this a seasonal operation?(Required)

Yes

No

What is the season? From & To(Required)

Does the business have a safety program?(Required)

Yes

No

Name of Safety Director(Required)

Safety Director Phone

Safety Director Email

Does the business have a disaster plan?(Required)

Yes

No

Name of Disaster Director(Required)

Disaster Director Phone

Disaster Director Email

Describe Primary Business Operations(Required)

Describe any secondary and/or incidental operations

Other Important People

Optionally include the Name and Phone of any additional important people. Examples include other owners/principals, decision makers, financial persons, legal persons, claims persons, etc.

Total Annual Payroll(Required)

Tenant Leasing & Improvements

Please describe any improvements or betterments that have been added

What is the length of term of the lease?

What is the lease renewal option term?

Is the lease in writing?

Yes

No

What is the agreed upon monthly rent?

Downpayment or non-refundable advance to rent the space? (if applicable)

Value of improvements and betterments

Does the business occupy the premises?

Yes

No

Does the business sublet any or all of the premises?

Yes

No

Is the lease between the business and sub-lessee(s) in writing?

Yes

No

Accounts Receivable

Average monthly amount of receivables over the past 12 months?(Required)

Maximum monthly amount of receivables over the past 12 months?(Required)

Where are the records of accounts receivables stored?

Are duplicates of records of receivables duplicated and stored separately?

Yes

No

How long are duplicates kept?

Livestock Information

Does the business have livestock?

Yes

No

Livestock

Primary type(s) of livestock?(Required)

Describe other types of livestock on premises other than Primary livestock

Is livestock raised on premises?

Yes

No

Where barns built for the current type of livestock?

Yes

No

Are livestock allowed free range outside buildings?

Yes

No

What security measures are in place to protect such livestock?

Mobile Equipment Information

List of equipment, or total $ amount per equipment type

Where is equipment kept?

% On premises in barn

% On premises in yard

% Off premises in barn

% Off premises in yard

% Other

Is any equipment loaned to others?

Yes

No

Does the business borrow equipment from others?

Yes

No

Environmental Impairment

List the chemicals used in the business operations

Describe business waste disposal procedure

Describe any tank storage on business premises

Has there been a recent inspection of the premises for contamination and/or an environmental assessment of the operations?

Yes

No

When, Why, and Who conducted the inspection

Does the business know about any existing pollution problems?

Yes

No

Have there been pollution damage or claims that allege pollution damage during the last 10 years?

Yes

No

Has the business discontinued any process(es) or abandoned any underground tank(s)?

Yes

No

Describe precautions taken to prevent pollution

Vehicle 1

1. VIN(Required)

1. Year

1. Make

1. Model

Add 2nd Vehicle?

Add Another Vehicle

Vehicle 2

2. VIN(Required)

2. Year

2. Make

2. Model

Add 3rd Vehicle?

Add Another Vehicle

Vehicle 3

3. VIN(Required)

3. Year

3. Make

3. Model

Add 4th Vehicle?

Add Another Vehicle

Vehicle 4

4. VIN(Required)

4. Year

4. Make

4. Model

Add 5th Vehicle?

Add Another Vehicle

Vehicle 5

5. VIN(Required)

5. Year

5. Make

5. Model

If you have more than 5 vehicles, we will reach out to you to gather the remaining ones.

Driver(s)

Do you have drivers that need to be insured?

Yes

No

Are business officers, partners, or employees furnished an automobile for their personal use?

Yes

No

Do individuals with a vehicle furnished by the business purchase auto insurance on vehicles they own personally?

Yes

No

Would you like to enter your driver(s) information now?

Includes list of names, date of births, drivers license #, and state of issuance

Yes

No

That's ok. If you have drivers that your business needs to insure, your agent can gather this information from you later.

Driver 1

1. Name

First Last

1. Date of Birth

1. DL#

1. DL State

Add 2nd Driver?

Add Another Driver

Driver 2

2. Name

First Last

2. Date of Birth

2. DL#

2. DL State

Add 3rd Driver?

Add Another Driver

Driver 3

3. Name

First Last

3. Date of Birth

3. DL#

3. DL State

Add 4th Driver?

Add Another Driver

Driver 4

4. Name

First Last

4. Date of Birth

4. DL#

4. DL State

Add 5th Driver?

Add Another Driver

Driver 5

5. Name

First Last

5. Date of Birth

5. DL#

5. DL State

Add 6th Driver?

Add Another Driver

Driver 6

6. Name

First Last

6. Date of Birth

6. DL#

6. DL State

Add 7th Driver?

Add Another Driver

Driver 7

7. Name

First Last

7. Date of Birth

7. DL#

7. DL State

Add 8th Driver?

Add Another Driver

Driver 8

8. Name

First Last

8. Date of Birth

8. DL#

8. DL State

Add 9th Driver?

Add Another Driver

Driver 9

9. Name

First Last

9. Date of Birth

9. DL#

9. DL State

Add 10th Driver?

Add Another Driver

Driver 10

10. Name

First Last

10. Date of Birth

10. DL#

10. DL State

If you have more than 10 drivers, your agent will reach out to you to gather the rest.

Wrapping Up

Do your business have current insurance or past insurance?(Required)

Yes

No

1. Carrier Name

1. Policy Expiration Date

2. Carrier Name

2. Policy Expiration Date

3. Carrier Name

3. Policy Expiration Date

Additional Comments

File Attachment(s)

Optionally attach any relevant documents. Some examples may include lease agreements, MVRs, vehicle or drivers lists, certifications, COI requirements, etc.

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB.

Please let us know the best time to call and discuss your quote

Morning

Afternoon

Evening

Anytime

How were you referred to us?

Since we are family owned and appreciate referrals, we like to send referrals a gift card to say thank you.

All the above information is accurate and true to the best of my knowledge.(Required)

Yes

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Name

This field is for validation purposes and should be left unchanged.

Farm Insurance Quote

Primary Contact Information

Secondary Contact Information

General Business Information

Property Information

Business Personal Property

Tenant Leasing & Improvements

Business Income

Accounts Receivable

Livestock Information

Livestock

Mobile Equipment Information

General Liability

Parking Lots and Sidewalks

Employees

Employees Off-Premises

Subcontractors

Advertising Information

Liquor

Employee Benefits

Environmental Impairment

Vehicle(s)

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle 5

Driver(s)

Driver 1

Driver 2

Driver 3

Driver 4

Driver 5

Driver 6

Driver 7

Driver 8

Driver 9

Driver 10

Wrapping Up

Redding & Allen Insurance

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