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Community Insurance Group
A Professional Agency With Personal Service
Community Insurance Group

Independent Insurance Agent
Trusted Choice
Community Insurance Group

Personal Inland Marine Insurance Quote

We would like to provide you with a free, no-obligation insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Personal Information
Applicant's Name:
Address:
City:   State:   Zip:
Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:

Applicant & Location Information
 
Age:
Marital
Status:
 
Occupation:
Spouse's
Occupation:
Territory
Code:
Protect
Class:
Fire District/
Code #:
S
Location of Property
(if different from above):
Dwelling
Type(s):
Construction
Type(s):
# Families
(in each):

Additional Location
Other: 

Coverages
Please indicate additional property that is not listed in boxes 10-14
#
Property
Amount of Ins.

#
Property
Amount of Ins.
  1 Jewelry $ 8 Coins $
2 Furs $ 9 Golfer's Equipment $
3 Fine Arts $ 10 $
4 Cameras $ 11 $
5 Musical Instruments $ 12 $
6 Silverware $ 13 $
7 Stamps $ 14 $
Unattended Car Coverage (Stamps/Coins)
Broad Form Pair & Set Coverage
Non-Mobile Organ Coverage
Safe Credit (Identify Property, Safe Class, Etc)
  ACV Loss Settlement
Replacement Cost Loss Settlement
Breakage Coverage (*On Schedule)
Blanket Coverage
Additional Rating Information

General Information
Explain All "Yes" Responses in Remarks
Yes/No

Explain All "Yes" Responses in Remarks
Yes/No
1. Any protective devices/systems in use? Y
N
6. Any other insurance with this company? Y
N
2. Will any property be exhibited? Y
N
7. Did any loss occur during the last 3 years? Y
N
3. Will any special restriction/ endorsements apply? Y
N
8. Any coverage declined, cancelled or non-renewed during the last 3 years? Not applicable in MO Y
N
4. Will any type of deductible apply? Y
N
Prior Insuror & Policy Number
5. Is any property used professionally/ commercially? Y
N
Remarks

Schedule of Property
#
Provide a detailed description of each item, from whom purchased, etc. Be sure to forward all required appraisals/bills. Purchase/
Appraisal Date
Amount of Insurance
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Please use "Additional Comments" section at the bottom of this form for any additional entries.

Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have
additional information where there was not enough fields above, please enter them here.


Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   

 
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Avalex: Route for Commercial Laundry

Community Insurance Group
Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.

Community Insurance Group
Community Insurance Group
139 Harristown Road, Suite 202
Glen Rock, New Jersey 07452
Community Insurance Group
Phone: 
Toll Free: 
Fax: 
Fax (NJ only): 
   201-444-4426
 855-344-4426
 201-444-0731
 800-440-2267
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