Business Insurance Pottstown PA

Buisness Quote Form

The Lowa Group, Inc. is extremely pleased to be able to offer you the finest protection. We have an impressive collection of property, casualty, and life products that can be tailored to meet your specific needs in today's business environment.

We offer all lines of business insurance at competitive rates:

Contractor's Insurance
Property and Liability Package Policies
Worker's Compensation
Business Catastrophe Liability (Commercial Umbrella)
Bonds

To receive more detailed information on our quality lines of business coverage or to request a quote, complete the form below and click the submit button. We will contact you promptly.

Name:

Address:

Name of Business:

Type of Business:

City:

Country:

State:

Home Telephone Number:

Work Telephone Number:

Cell Phone:

Fax Number:

Email Address:

Spouse's Name:

Social Security Number:

Years in Buisness:

Policy Period:

Business Entity:

Interest in Premises:

Type of Business:

Description of Operations:

Mortgagee name &address:

LIMITS OF INSURANCE and OPTIONAL COVERAGES

Building:

Replacement Cost:

Actual Cash Value:

Construction:

Frame Joisted Masonry

Masonry Noncombustible Fire Resistive

Sq. foot area of each building:

Year of Construction:

Number of stories:

Business personal property:

Deductible:

Exterior Glass:

Yes No

Sign:

Yes No

Money & Securities $10,000 Inside/$2,000 Outside

Systems breakdown/ boiler & machinery

Yes No

Non-owned & Hired Automobile

Yes No

Annual Sales:

Annual Payroll:

Accounts Receivable:

Valuable Papers:

Business Computer Hardware:

Business Computer Software:

Employee Dishonesty:

Business Liability:

Additional Insured Name and Address:

3 YEAR PRIOR CARRIER

Policy #1:

Expiration Date: Premium:

Policy #2:

Expiration Date: Premium:

Policy #3:

Expiration Date: Premium:

LOSS HISTORY

Date of Loss:

Loss Descr. Amount Paid:

Date of Loss:

Loss Descr. Amount Paid:

Date of Loss:

Loss Descr. Amount Paid:

REMARKS:

How Did You Hear About Us?

Quote requested within:

24hrs 48hrs 72hrs 120hrs

How do you want to recieve your quote?

Via E-mail Fax Telephone