M
ikkelsen
I
nsurance
S
ervices
Information needed for In-Home Business Insurance quote! Please complete all blanks.
California only!
(Our
Privacy Statement
)
Name:
Business Name:
Address:
City:
Calif.
Zip Code:
Phone:
Own or rent premises:
How many years in Business:
Detailed and complete description of your business:
Estimated Anual Gross Revenues: $
Value of all EDP - hardware & software: $
($25,000 Max.)
Value of all other Business Personal Property: $
($50,000 Max.)
Liability limit desired?
$300,000
$500,000
$1,000,000
E-mail address:
Before you press the "Send" button please check the form for completeness and accuracy. We can not process requests with incomplete information. If you prefer you may print and fax to 209-839-08632
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