MRW Group Insurance

Business Quote

General Information
Contact Name *
Email *
Business Name
Address
City
State
Zip
County
Business Phone
Fax
FEIN #
Current Insurance Company
(not agency)
Company Name
Policy Expiration Date
Current Insurance Coverages
Current Coverages Bond
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
Disability
Group Health
Group Life
Professional Liability
Workers' Compensation
Other
Business Information
# of Full-Time Employees
# of Part-Time Employees
How long in Business? (yrs)
How many locations?
Please give a brief description of your business and clientele
Property/Premises Information
Address
Occupancy Status Owner  Tenant
Year Built
% Occupied
Sprinklers Yes  No
Construction Type
Stories
# Basements
Sq. Footage
Burglar Alarm Yes  No
Building Value
Contents
Other Property (specify)
Insurance Information
Other
Annual Gross Sales: (before taxes)
Number of Employees
Annualized Payroll
Cost of any Subcontracted Work
Limits Requested $300,000
$500,000
$1,000,000
$2,000,000
Describe any claims you've had in the past 5 years
Additional Comments
* = Required Field
Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
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MRW Group Inc. is a full-service independent insurance agency offering a multitude of insurance products from top-rated companies to fulfill all your insurance needs. Our objective is to provide superior customer service and quality insurance solutions to all our customers. MRW Group is dedicated to getting you the the best insurance products and services available today to protect you, your family and your business.

We have access to rates with more than 45 insurance companies to get you the best coverage at the lowest cost.

Please visit or contact us at one of our three offices on Long Island, New York in Huntington, Medford and Rockville Centre, our dedicated, professional staff members are ready to give you the personal attention you deserve.

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