Business Owners Insurance Quote Request

Please take a moment to fill out the form below and one of our representatives will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

* Required fields.

General Information
Your Full Name: *
Your Company: *
Address: *
City: *
State: *     Zip:  *
Business Phone: *  
E-mail Address: *
  FEIN # 
 DBA        Corporation           LLC              Other 
 
Current Insurance Information
Company Name:
(not agency)
Policy Expiration Date:   Premium Amount: $
Years Insured:

About Your Business *
Number of Employees: Years in Business:
Number of Locations:
Annual Sales: $
Any Losses in Last 5 Years  *
Detailed Description of your Business: *

Property Questions
Do you own
your Building?		 Yes
No 		Building Replacement Value: $
    Replacement Value of Contents: $
Do you have
Company Vehicles?		 Yes
No 		If Yes, How many?

Additional Comments or Questions

Please click the "Submit Quote" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.

**Privacy Policy Notification**

In order to determine your eligibility, we are required to verify your loss history and credit history using consumer reports. You understand and agree that any personal information about you that you provide or that we obtain from any consumer report may be used by any company within the Nationwide Insurance group of insurance companies to issue, review and renew the insurance for which you are applying. You have the right to access and correct all personal information collected.

If you do not want us to order a credit and claims report, we can still provide you with a conditional quote; however without these reports, the quote may be rather inaccurate and cannot be used as final rates for your mortgage company or budgetary purposes.


The Howard French Insurance Agency
2616 South Loop W., Suite 597
Houston, Texas 77054
281-677-9491 office | 281-677-9492 fax

"The greatest compliment we can receive is your referral."