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Compass Insurance Group's underwriting companies
, we will collect information from consumer reporting agencies, such as driving record, claims, and
credit history
reports. Future reports may be used to update or renew your insurance.
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How did you hear about us?
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Referral
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Internet Link
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Other
Email Address (required in order to receive your quote back):
First Name:
Middle Initial:
Last Name:
Suffix:
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Jr
Sr
I
II
Address:
Apt/Room #:
City:
State:
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
D.C.
Florida
Georgia
Hawaii
Idaho
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Phone:
Will this insurance replace an existing business policy?
Yes
No
If no, please continue to the
Business Profile
.
If yes:
Who is your most current insurance company?
When does your current policy expire/renew?
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
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05
06
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18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2007
2006
2005
How long have you been insured with your current company?
# of Years
01
02
03
04
05
06
07
08
09
10+
# of Months
01
02
03
04
05
06
07
08
09
10
11
IMPORTANT:
How long have you been
continuously
insured?
# of Years
01
02
03
04
05
06
07
08
09
10+
# of Months
01
02
03
04
05
06
07
08
09
10
11
Business Profile
To help our insurance agents better understand your business insurance needs, please provide the following information about your business.
Business Name:
What is the business operating status?
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Corporation
Limited Liability Corporation
Partnership
Sole Proprietership
Other
Please provide a brief description of the business:
About how many full-time employees?
Approximately when did the business begin operating?
Month
01
02
03
04
05
06
07
08
09
10
11
12
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year:
What is the estimated average annual revenue?
--- Select ---
Under $100,000
$100,000 - $500,000
$500,000 - $1,000,000
$1,000,000 - $10,000,000
Over $10,000,000
Business Policy Coverages
Select any of the following coverages that you would like your insurance agent to include in the quote.
Click on any coverage term to see a
definition
.
Bonds
Directors' and Officers' Coverage
Business (Income) Interruption
Employment Practices Liability
Business Owners Policy
Errors and Omissions
Commercial Auto
Technology Business Package
Commercial Crime
Workers Compensation
Commercial General Liability
Other
Commercial Package Policy
Please enter any further information
or questions about desired coverages:
I have read the Information Disclosure and
Privacy Policy
and would like to receive my quote.
Yes
No
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