Business Insurance Quotation Form

For a Business Insurance quotation for the state of Kentucky, please fill out the following form and click the submit button. An agent with The Lancaster Agency will contact you to review a personalized quotation as soon as possible. Please note that The Lancaster Agency is authorized only to write insurance in the state Kentucky.

Thank you for your quotation request. Questions? Please contact us.

Personal Info

Name (first, middle I. last) :

Address Line 1:

Address Line 2:

Address (city, state, zip code) :

Home Phone:

Work Phone:

E-mail:

Fax:

Best time to call:

Social Security # (required):

Business Information

Type of business:

Other:

Number of employees:

Full-time Part-time Annual payroll

How long in business:

years

Approximate annual sales:

Please provide a brief description of your business and clientele:

Coverage Information

Coverage:

Commercial Auto	General Liability
Commercial Property	Business Personal Property
Computer Coverage	Umbrella
Workers' Compensation	Other

Comments and additional pertinent information:

Submitting an insurance quotation request to The Lancaster Agency does not constitute a binding confirmation of new or altered insurance coverage. Verbal or written confirmation must be obtained from The Lancaster Agency to confirm binding or altering coverage.