Request a Business Owner Quote
       
* Mandatory Fields
 
General Information
Company/Business Name:*
Business Address:
City: State:
Zip: Country: United States
Phone: Fax (Optional):
 
Contact Person Information
First Name: *
Last Name:
 
Day Phone: Night Phone:
Best Time To Call(HH:MM):     AM   PM
E-mail Address: *
 
 
Please Tell Us About Your Business
Number of Full Time Employees: Number of Part Time Employees:
Number of Years in Business: Number of Business Locations:
Type of Business:
Annual Gross Sales (Before Tax) ($): Cost of Any Sub Contracted Work ($):
Please give a brief description of your business & clientele:
 
Location 1 Information
Address:
City: State:
Zip: Country: United States
Year Built In: % Occupied:
Building Value ($): Contents ($):
Type of Ownership:    
Construction Type:
Number of Basements: Area (Sq. Feet):
Burglar Alarm:       Sprinklers:      
 
Location 2 Information
Address:
City: State:
Zip: Country: United States
Year Built In: % Occupied:
Building Value ($): Contents ($):
Type of Ownership:      
Construction Type:
Number of Basements: Area (Sq. Feet):
Burglar Alarm:       Sprinklers:      
 
Current Insurance Information
Insurance Company Name:
Policy Expiry Date (MM/DD/YYYY): Premium Amount ($):
Any Losses In Last 3 Years?       Same Company Policy Since?
 
Please Provide An Approximate Amount For The Type Of Coverage You Want
Choose The Type of Coverage You Are Looking For:
Liability Coverage (Ex. $300,000, $500,000, $1 Million, etc.): Building Coverage ($):
Business Content Coverage ($): Miscellaneous Coverage ($) (All Coverage including Loss of Earnings, Valuable Papers, etc.):
Any additional comments or information that might be helpful in your Business Owners insurance quote:
 
Disclaimer
No coverage of any kind is bound or implied by submitting information via this online form.
  • We will only use information provided to assist in obtaining appropriate insurance quotes and coverage.
  • We will not distribute information to other parties other than for insurance underwriting purposes.
  • By checking the box below you agree to release us from any liability should this information be accidentally viewed by others.


Address:

GYC Insurance Agency LIC#0f88072
2901 West Coast Hwy, Suite 200,
Newport Beach, CA 92663.

Phone:
(714) 848 8885
Fax:
(714) 375-3894
E-mail:
jeanette@gycins.com

Client Testimonial

 
 
 
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