low cost missouri personal and business insurance from Whitney Harrison Insurance Agency
  Return to Home Page
Visit Our Agency's
Low Cost Missouri
Insurance Resources
Personal Lines
low cost missouri personal and business insurance from Whitney Harrison Insurance Agency
Commercial Lines
  Our Other Services
low cost missouri personal and business insurance from Whitney Harrison Insurance Agency
  • Service My Account
  • Company Service Sites
  • About Our Agency
  • Office Directions/Map
  • Our Privacy Statement

    E-Mail Us:
    email Whitney Harrison insurance
    larryb@whitneyharrison.com
    Whitney Harrison
    Insurance, Inc.
    2412 S. Franklin
    Kirksville, MO 63051

    Toll Free: 800-748-7185
    Local Phone: 660-665-1212
    Fax: 660-665-9444

    Whitney Harrison insurance guarantees your Missouri insurance satisfaction!
    		•     
     

    On-Line Contractor
    General Liability Quote Form
    One Simple Form - takes only 2-3 Minutes!
    Your Name:
    BUSINESS Name:
    Mailing Address:
    City:
    State: (Must be Missouri)
    Zip/Postal:
    E-Mail (REQUIRED):
    E-Mail again for accuracy:
    Phone:
    Fax (optional):
     
    Business Underwriting Information
    Type of operation:
    Describe operations in detail:
    License class:
    License Number:
     
    Limit of Liability
    Coverage Requested?    		 $300,000
    $500,000
    $1 Million
     
    Currently Insured? Yes No
    Name of Carrier & how long insured?
    Prior Claims? Yes No
    Describe claims in detail:
     
    Years in business:
    Years experience in field:
    Percentage of work residential:
    Percentage of work commercial:
     
    Number of Active Owners:
    Number of Employees (full & part time):
    Annual Employee Payroll: $
    Annual Gross Sales: $
     
    Do you subcontract work? Yes No
    (If yes, what percentage of your work
    is subbed, and what kind of work?)
    Do you do foundation work? Yes No
    Do you work on condos? Yes No
    Employees paid over $18/hour? Yes No
    Do you have a safety program? Yes No

     
    Comments/Remarks:
     
    Send my quotation via: E-Mail Fax
    Regular Mail
    Please Call Me!

    Thank you for filling out this form COMPLETELY!

    We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

    Yes, I Agree. Please Send Me a Quote NOW!

    Click Button Below When Done

    Please Click Only Once . . . May take up to 30 seconds!

    		 
    Website Design © 2010, Insurance Web Sales