Horizon Agency
 A leading provider of insurance products to individuals and businesses for over 30 years.
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QUICK QUOTE FORM

To receive a quick quote on your coverage, please complete the form. The form fields in bold must be filled in prior to submitting the form. If you would prefer to mail or fax us your quote form, click here.

General Information

Company Name:
Contact Person:
Phone Number:
Fax Number:
Email Address:
Website:
Address:
City:
State:
Zip Code:
Current Insurance Carrier:
Current Expiration Date:
Current Annual Premium:
Estimated Sales:
What is rental percentage?:
Years in Business:
How many losses in the past 3 yrs?:
  # of Employees
Part-Time:
Full-Time:

Building/Contents Information

Year Built:
Square Feet:
# Stories:
Year electrical was updated:
Year roof was updated:
Building Value (if insured by you):
Contents Value (Avg):
Contents Value (Max):
Deductible:

Ownership: Tenant Owner
Construction: Frame Brick Cement/Steel
Type: Free Standing Strip Mall Shopping Center
Sprinklers: Yes No
Burgler Alarm: Yes No
Do you provide: Guided Tours
Instructions/Lessons
Do you sell or rent:

Skis
Snowboards
Kayaks/Canoes
Bikes
Patio Furniture
Fire Arms & Ammo
Other:

Do you have: Skate Park
Rock Wall
Pool/Lake
Other:
Additional Quotes: Work Comp
Business Auto
Umbrella
Health
Other:
Comments: