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Specializing in convenience industry.  Among the largest insurers of gas and convenience stores in lower NY (NYC, Rockland, Westchester, Putnam, Dutchess & Orange Counties.)

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Business Insurance Quote Request

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Contact Information
* First Name:
* Last Name:
* Address:
* City:
* State/Zip:
,
* Work Phone:
(+ area code) Ext.
Fax:
(+ area code)
E-mail:
Best to call:
Business Information
* Business Name:
* Address:
* City:
* State/Zip:
,
* Business Description:
Annual Sales:
Annual Payrol:
No. Owners or Officers:
No. Full Time Employees:
No. Part Time Employees:
Business Occupancy:
Office Storage
Construction:
Frame Masonry
Building Limit (if owned):
Content Limit:
Value of Tools & Equipment:
Loss History
(List all losses in last 3 years):
Enter Dates, descriptions and amounts for each occurance:
Have you had previous insurance?:
Yes No
If yes, how many years?:
When does it expire?:
  (mm/dd/yyyy)
Comments
Validation Code:
* Validation Code:

Please Note: Insurance coverage cannot be bound without a written binder from our office.