Nielsen Insurance Group

For All Your Insurance Needs ...
Artisan Contractor Insurance Quote.

Please fill out the form Completely. All information provided here will be sent in a secure fashion to our web site and kept confidential. If the business is not placed with our agency, this information will be destroyed.

Contact Name:

Business Name:

Address:

City:

Zip Code:

Phone Number:

Email Address:

Best Time  to Call:

AM

PM

Do you have insurance now?

Present insurance company:

My policy expires:

Yes

No

Describe your business operations:
(What do you do?)

Type of License:

Any claims in the past 3 years?

YES

NO

If yes, please explain here:

% Residential:

Do You Have Current Loss Runs?

YES

NO

% Commercial:

Have you built single family homes
or condominiums in the past?

YES

NO

% New Construction:

Do you plan to built single family homes or condominiums in the future?

% Remodeling:

YES

NO

Length of time in business

Working under your name:

Years

Working for others:

Years

Number of Full Time Employees:

Number of Part Time Employees:

Annual Payroll:
(Except of owner
and clerical)

Annual Sales/Gross Receipts:

Annual Amount subcontracted
to others:

What operations are subcontracted?:

What amount of coverage do you need?

List any additional coverage you
Would like to have included here:

Comments or Questions:

When finished, click the "submit" button below. Your request will be delivered to us immediately. Thank you!