Independent Insurance Agency
Hyannis Office: (508) 775-6060    Dennis Office:(508) 398-6060
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Commercial Insurance

Please complete this form and submit it. Someone from our office will get back to you within 2 business days.
If you need help please call us at 508-775-6060 or send an email.

1. Company Name

2. Address

3. City
 State
 Zip

4. Email

5. Contact Person:

6. Area Code and Office Phone / Ext:

7. Area Code and FAX Phone:

General Information

8. Effective date of coverage

9. Full description of your business (This will help us identify your insurance needs)

9a. Describe your business

9b. List year business was established

10. Is this a seasonal business? Yes No

11. Do you currently have business insurance? Yes No

12. If insured, name company insured with

13. Choose which type of business insurance you would like a quote on

14. Annual Gross Receipts

15. Total Annual Payroll

16. How Many Employees

17. Have you had any insurance claims in the last three years? Yes No
17a. If yes, please describe and list amount of claim settlement.

18. Do you own your company's building? (Not applicable if you work out of your home) Yes No
18a. If yes, state building replacement value $

19. Deductible (choose one)

20. Are you the only occupant in your building? Yes No
20a. If no, describe other tenants (i.e. restaurant, retail etc.)

21. If you are a tenant, are you required to insure the building? Yes No
21a. If yes, Sstate replacement value $

22. List building address if different than mail address / City / Zip

23. Age of Building

24. Building Construction

25. Is Building Alarmed? Yes No
25a. If yes,
a. Burglar Alarm Yes No
b. Smoke Alarm Yes No
c. Central Station Yes No

26. Sprinkler System in building? Yes No

27. Business Personal Property (Contents) State Replacement Value $

28. Deductible (choose one)

29. Commercial General Liability (choose one)

30. If you are a contractor, list value of tools & equipment (exclude vehicles) $

31. Computers? Yes No
31a. If yes, replacement value $

32. Signs? Yes No
32a. If yes, state replacement value $

33. Questions / Comments

Help?

When filling out this form, leave blank any fields for which you do not know the answer. Be sure that you give us either an email address or a phone number so that we can call you back. If you haven't heard from us within one business day please call and follow up with us.

Insurance Coverage Available - Local to Cape Cod, Barnstable, Hyannis, South Dennis

  • Homeowners Insurance
  • Renters Insurance
  • Automobile Insurance
  • Flood Insurance
  • Commercial Insurance
  • Workers Comp Insurance
  • Liability Insurance
  • Health Insurance Insurance
  • Life Insurance Insurance
  • Dental Insurance
  • Long Term Care Insurance
  • Annuities Insurance
  • Disability Insurance
  • Umbrella Insurance
  • Bonds
  • Boat Insurance
  • Wedding Insurance
  • Event Insurance