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Salon or Barber Shop Quote Form


Contact Information
Full Name(Required)
Mailing Address(Required)
Business Type(Required)

Business Address(Required)
What Would You Like Quoted (Check All That Apply)(Required)

General Liability Information
Describe Your Operation(Required)
Salon, Barber Shop, School, etc
Fill in Below or Enter 0
Botox or Filler Offered(Required)
Does a Doctor or Licensed Practitioner Preform Any Type of Service at the Salon or Shop?(Required)
# of Employees or 1099s


Building & Property Information
Where is the Salon or Shop Operating(Required)


Insurance
Do You Currently Have Insurance(Required)
Has There Been a Lapse of Coverage in the Last 3 Years
Any Claims the Past 3 Years(Required)

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(Required)
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ADDITIONAL INFORMATION NEEDED

After you have submitted your quote request, we will start working on your quote and we will help assist with obtaining your claim history. The insurance carriers require us to show prior proof of coverage along with claim history. Thank you for your time and we will be in touch with you today unless this is after hours or on the weekend.
Debbie Ward
Debbie Ward, AAI
Agency Owner


Please view our Privacy Policy at: Privacy Policy

Special Note
If insured, we are required to obtain a copy of your current policy and loss history.

How can we help you?

Our goal is to make insurance purchasing as simple as possible by taking the frustration out of buying.

Call Us 770-974-0670

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