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Home > Business Commercial > Business Insurance
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Business Insurance


D. Ward Insurance Services, Inc. since 1988
       
  • Multiple Carriers Will Compete
  • Contact Same Business Day

Our Highly Rated Insurance Carriers:   

Hartford * Auto Owners * Safeco * Progressive * Utica * American Strategic * United States Liability * Mercury, and more.  



BUSINESS INSURANCE QUOTE FORM
The Quote Form is our preliminary process of obtaining the necessary underwriting information. Be as thorough as possible. The current policy and claim history will also be required as part of the underwriting process.
First Name *
Last Name *
Contact Primary Phone Number *
E-Mail Address *
Business Legal Name *
Doing Business As Name or Type "NA" *
Number of Years in this Business? *
What type of Insurance do you want us to quote?






Mailing Address *
City *
State *
ZIP / Postal Code *
Business Type *




Number of Owners or Officers *
Describe your Business Opeartion *
Business Location (Indicate "same" if it is same as mailing address) *
City, State & Zip for Business Location (Type "same" if same as mailing address) *
Current Estimated Gross Annual Sales or Receipts *
Number of Employees (excluding Owners and Officers) *
Annual Employee Payroll (Excluding Owners or Officers) *
Are Subcontractors Used? *

If Subcontractors are used, do you veritify that they have insurance? *


Number of Non Employees 1099s *
Annual Cost of Non Employees 1099s or type "NA" *
Annual Cost of Subcontractors or Type "NA" *
BUILDING & CONTENTS INFORMATION
Do you own the Building? *

How much Contents Coverage should we quote? *
Construction Type *
Total Building Square Footage? *
Your Occupied Square Footage *
Year the Building was Built (est) *
Age of the Roof *
Is there a sprinkler system in building? *

CURRENT INSURANCE INFORMATION
Do you currently have Business Insurance? *

If yes, please provide name of current Insurance carrier. If no insurance, type "NA." *
Has there been a lapse in coverage in the last 3 years? *

Number of Additional Insureds Needed, if applicable or type "NA" *
Has your business had any claims in the past 3 years? *

Is there anything else that you would like for us to know concerning your up and coming Renewal?
How did you hear about us? Please let us know *
SIGNATURE REQUIRED
I have provided all of the above information for insurance purposes and I state all information is true to the best of my knowledge. I also understand that I am to discuss with the agent at D. Ward Insurance my desired limits and coverage.
By typing my name warrants my signature. *
ADDITIONAL INFORMATION NEEDED
Please note - if the Business is insured, a copy of the policy and claim history will be required. They can be obtained from your current agent by requesting the documents to be sent electronically to you.
Thank you for time and we will be in touch with you today unless this is after hours or on the weekend - Debbie Ward and Valerie Moore
ENTER VALIDATION CODE
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Submission Validation
Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages.  Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company.  If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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Mailing: 1720 Mars Hill Rd #8-185, Acworth, GA 30101
Physical: 3440 Blue Springs Road, #503j, Kennesaw, GA 30144

P: (770) 974-0670 | F: (770) 974-8577 |
E: dward@dwardins.com

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