(870) 352-2155
Fordyce, AR
Milton Insurance Agency
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Fordyce, Dallas County, AR General Liability Quote Form - Protect Your Business
General Liability / Contractor Insurance Quote
Contact Name
*
Company
Address
*
City
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County
Zip
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Email
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Phone
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Classification
How Did You Find Us?
How Did You Find Us?
Google Search
Referred by Individual
Referred by Contractor
Advertisement/Mailing
Other Method
Tell Us About Your Operations
Type of Business
# Active Owners
# Full-time Field Employees
# Part-time Field Employees
Contractor License #
Work on New Tracts?
Yes
No
Work on New Condos, Townhomes, or Apartments?
Yes
No
Work Percentage (Must Equal 100%)
New Commercial
Service & Repair
Residential
Miscellaneous Industrial
Remodel
New Custom Homes
Company Information
Annual Payroll (exclude owners)
$
Annual Gross Receipts
$
Annual Sub Costs
$
Current Insurance Carrier (If none, enter "none")
My Policy Renews (Current date if not insured)
Provide detailed description of your contracting operations. The more complete the description, the more accurate your quote will be.
Note: Coverage Can Not Be Bound Changed Or Deleted Via Electronic Message
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