Commercial Insurance Quote Form

Welcome to Weber Insurance's Commercial quote form.  To request a quote, please complete as much of the form as possible.  If you leave the form, use the back button on your browser to return to the form.  This form will be emailed to us.  All information entered is confidential.

DO NOT USE THE "ENTER" KEY

USE THE "TAB" KEY  

OR YOUR MOUSE

TO MOVE FROM FIELD TO FIELD.
 
 

Tell me how to get in touch with your buyers:

 

Buyer - 1

Buyer - 2

Name - include   Mr, Ms or Mrs*   
Date of Birth
SS # 
Occupation*
Home Phone*
Work Phone
Cell Phone
Mailing   Address*
City*
State*  
Zip Code*
E-mail
Send Quotes via

 CAUTION, IF YOU LEAVE THE FORM, USE THE BACK BUTTON ON YOUR BROWSER TO RETURN.  ANY OTHER BUTTON WILL CLEAR THE FORM OF ALL DATA ENTERED.

Property to be insured
Settlement Date*    
Address or MLS#*    
City * 
State*    
Zip Code*  
County and Township  
How will the Home be used

List Type of Occupancy (Apt, Store, Office, etc.)

  
Number of Units in Building*    
Number of families*  occupying the home    
Occupancy *   
Is premises currently occupied*    
Is premises vacant*    
If vacant - what percentage of the premises is vacant*    
If vacant - how long has it been vacant*    
Will the premises be renovated*    
If yes, describe type of renovation and total estimated costs (i.e. Kitchen, bath, flooring, utilities, painting)*  
Is the premises currently being used or will it be used for a rooming, boarding, senior, student or HUD housing*  
How much Insurance is Needed
Sale Price $*    
Mortgage Amount $*  
Square Footage   

 

 

     Enter your Realtor's name, office, phone and fax numbers:

Example: XYZ Realty - Exton Office - 610-555-5555 - FAX 610-444-4444

 

Name and phone number of person completing this form: 

Please contact me as soon as possible regarding this matter.

 
 
 Be patient, it will take some time for the information to be processed.  A Form Confirmation will be displayed.  Please review the information you entered.  If you need to correct any information, use the "Back" arrow on your browser to return to the form with the data you entered still in the form.  Clicking on "Return to the Form" will erase all data and return you to an empty form.

Are you ready to send this information? (type "YES")                      

 
 
   

                    

 

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Revised: August 12, 2010 .