Schick Insurance Agency - Providing Insurance Services to South New Jersey and Cape May County residents since 1983

Business Owners Insurance Form

Answer the following questions and click the Submit button.

Your Confidential information will be processed and you will be contacted.

SECTION 1: YOUR INFORMATION
Please provide your information as completely and accurately as possible so we can in turn provide you with an accurate quote. *FORM FIELDS LABELED IN RED ARE REQUIRED
Business Name:
First Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Phone:
Cell Phone:

Please provide your information as completely and accurately as possible so we can in turn provide you with an accurate quote.

Description of Business:

Do you own or lease your building?

Own Lease

Square Footage of Building:

Age of Building:

Coverage Amount on Building:

Coverage Amount on Contents & Business Property:

Limits of Liability:

Year Established:

Annual Gross Revenue:

Total Company Payroll:

Previous Insurance Losses

When is coverage requested?

/ /

Business comments:

Tell us of any special circumstances pertaining to your business:

Do you need workmans compensation?
Yes No

Please verify that all infomation is correct
before hitting the submit button:

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