low cost missouri personal and business insurance from Whitney Harrison Insurance Agency
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low cost missouri personal and business insurance from Whitney Harrison Insurance Agency
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    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!
    		•     
    Garage/Auto Repair Shop
    Insurance Quote Form
    One Simple Form - takes only 2-3 Minutes!
    Your Personal / Company Data:

    Your Name:
    Your Company's Name:
    Street Address:
    City:
    State: (Must be Missouri)
    Zip/Postal:
    E-Mail (REQUIRED):
    Phone:
    Fax (optional):
    Your Business Type: Corporation
    Partnership
    Individual
    Other

     

    Currently Insured?
    (If yes, list carrier, and Policy Dates.
    If none, type NONE)
     
    Current Premium (cost) $
     
    List Claims & Amounts Paid
    During Last 5 Years
    (If none, type NONE)
     
    Policy Form:
    		 Claims Made    Occurrence
     
    Retroactive Date (if any):
     
    Years In Business:
     
    DOT Shop Identification
    Code(s) Number:
     

     
    Underwriting Information:
     
    Describe IN DETAIL,
    Your Business Operations:
     
    Operations Data:
    Describe IN DETAIL,
    Your Business Operations:
     
    Ownership & Payroll Data:
    List Employee's Annual Payroll Here (if none, enter $0): $ Insert # of
    Employees here:
     
    Location & Sales Information:
    Insert Annual Gross Revenues from this operation here: $ Square Footage of office or business location:
     
    Type of Building (wood frame, concrete, etc.): Number of Stories:
     
    Are there other business/residences in this building (describe)?: Describe safety features (alarm, sprinklers, fire protection, etc):
    Provide breakdown percentages of work provided:
    Passenger %  Truck %  Off-the-Road %
     
    Coverage Desired: (Check One Please)
    Policy Type I am Interested In:
    Claims Made Form
    Occurrence Form

    Limits of Liability Coverage I am Interested In:
    $250,000
    $500,000
    $1 Million
    $5 Million
    Limit of business property needed:
    $

    Limit of Garagekeepers Coverage Needed:
    (Total amount of vehicle left in your possession.)
     $
    NOTE: Don't worry if you are not exactly sure about coverage type... we will suggest the best coverage for you - just try to tell us what you are looking for! (If we need more info. we will let you know.)
     
     
    Send my quotation via: E-Mail Fax
    Regular Mail
    Please Call by Phone!

     
    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 us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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    Garage/Auto Repair Shop Insurance Quote NOW!

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