Schmutter Strull Fleisch Inc., New York, NY 10011

Commercial Insurance Coverage Inquiry

Please enter basic information below so that we can contact you to explore your Insurance needs.

Please note that fields with an asterisk (*) are required.


I. Please identify yourself
	Name*

	Company*

	Phone*

	Email*

	Best time to contact




II. Describe Your Business
	Type of Business

	Approx. Sales

	Address

	City

	State	Zip Code -

	No. of Facilities	Total Sq. Ft.

	Facility Ownership




III. Describe Vehicles To Be Insured Please indicate the types of vehicles you have and the total number of each.
	Type of Vehicle	How many?

	Type of Vehicle	How many?

	Type of Vehicle	How many?

	Total Vehicles




IV. Coverages Desired
	Check all that apply	Property/Liability Vehicles
		Prof. Liability/E&O Workers' Comp


	Specialized

	Specialized




V. Comments



I understand that no changes to my policy will take effect until you review this request and I receive a confirmation that coverage changes are in effect.