New Client Onboarding


Client Name and Contact Information

Is your Company a Profit or Non-Profit?

Let us know the savings you want!

Where would you like to save $$$$

Please call Comcast directly to verify the following information.
1-800-391-3000 Option "0"  Call 24/7 

I'll provide Comcast Bill later. (check the box)
Commercial Insurance Information Request to Quote Policies
Please provide the following information:
• Provide a current copy of each policy reflecting "Coverages, Limits, Classifications/Class Codes, Rates, Exposures & Premiums" are most important pages on all policies (you can take pictures with your phone if that's easiest and attach):
   o General/Professional/Pollution & Umbrella Liability Policies
   o Property/Inland Marine o Business Auto Policy, including:
         ▪ Full schedule of vehicles (year, make, model, vin #)
         ▪ Drivers List (full names, DL #, DOB)
   o Workers Compensation Policy showing: Class codes/job descriptions, current payrolls & rates
• Provide a current/past completed application or Complete attached application
*Additional information may be needed depending on type of risk

I'll provide Insurance Bills &
Policy later. (check the box)