425 South Mount Shasta Blvd.
Mount Shasta, CA 96067
Phone
: (530) 926-4500
Fax: (530) 926-1809
Email: Customerservice@mpiins.com

Commercial Insurance Quote:

General Information:

Name

Address

City

State

Zip

County

E-mail

Phone

Best Time to Call

Current Insurance Company (not the company of your agent):

Insurance Company Name

Policy Expiration Date

What type of coverages do you currently have?

 

Bond

 

Commercial
Umbrella

 

Group Life

 

Commercial
Auto

 

Directors &
Officers
Liability

 

Professional
Liability

 

Commercial
Liability

 

Disability

 

Workers’
Compensation

 

Commercial
Property

 

Group Health

 

Other

Tell us about your business:

Number of full-time employees?

Number of part-time employees?

How long have you been in business?

How many locations do you have?

What is your annual sales revenue?

Give us a description of your business activities and clients:

What coverages are you interested in having in the future:

 

Bond

 

Commercial
Umbrella

 

Group Life

 

Commercial
Auto

 

Directors &
Officers
Liability

 

Professional
Liability

 

Commercial
Liability

 

Disability

 

Workers’
Compensation

 

Commercial
Property

 

Group Health

 

Other

Please give us any additional information that may be unique to you:

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