Commercial EZ-App

Step 1 of 2: Submit

For Fast service on your commercial accounts complete the form below and click "Continue". Your submission will be electronically delivered to the next available Commercial Lines Underwriter.

Coverage Requested 
Prior Losses? 
Has applicant had any policies or coverage's cancelled or non-renewed in the past three years? 
Has applicant had prior Bankruptcy in the past 7 years? 
Have any crimes occurred or been attempted on the premises with the last 3 years? 
Willing to Renew? 

General Liability ( Fill out if you choose Package or Monoline Liability)

Does the applicant lease Employees

Property ( Fill out if you choose Package or Monoline Property)

Sprinkler?:
Central Alarm?:
Is Building 100 percent on Circuit Breakers?:

If over 20 years old, provide building updates:

Building Updates / (Year)

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?