Commercial Liability Insurance from Insurance Network of Louisiana

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Contact Information

First Name ✶

Last Name ✶

Phone ✶

Title

Business Information

Location

Business Name ✶

Federal EIN (Employer Identification Number) or Business Tax ID (FEIN) ✶

How many years has your business been in operation? ✶

Enter 0 if newly started this year.

How many owners does the business have? ✶

Include yourself and any co-owners or partners.

Street Address ✶

City ✶

State ✶

ZIP ✶

General

Business Type ✶

Industry ✶

Website

Operations

Description of Operations

Annual Revenue ✶

Estimated Annual Payroll ($) ✶

Number of Employees ✶

Number of Business Vehicles ✶

Number of Drivers ✶

Coverage Information

Current Insurance Company ✶

Current Policy Expiration ✶

What types of coverage are you interested in?

Commercial Auto

Commercial Liability

Commercial Property

Commercial Umbrella

Cyber Liability

Workers Compensation

Additional Information

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