Ohio Product liability Insurance quote request from Ohio-Auto Insurance.com

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Hear From You.

E-mail:
rogerk@kisoh.net

23366 Commerce Park,
Suite 200
Beachwood, OH 44122
Phone: 1-216-397-5890
Fax: 1-216-464-0095
Toll Free: 866-428-8614

Insurance License #14365

On-Line Product Liability Insurance Quote Form One Simple Form - takes only 2-3 Minutes! Your Personal Data
Your Name:
Business Name:
Property Address:
City:
State:	MUST be Ohio!
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):

Underwriting Information

Primary Policy Holder's Social Security Number or Corporation Federal Tax ID#: (Some carriers use credit history to qualify, this information is REQUIRED)

Date Coverage Needed:

Prior Carrier:

Describe Business:

Gross Annual Receipts:	$

Gross Annual Payroll:	$

Square Footage of Your Business Location:	$

Number of Employees:

Tell us what kind of product coverage you are looking for, and why:

How long do your products remain in use or on market?

Who manufactures your product and where?

Prior Claims?	Yes No
Describe claims in detail:

Limits & Coverages:

Liability Limits: $100,000 $300,000
$500,000 $1 Million

Business Contents Needed?
If so, list type and amount:

Comments/Remarks:

Send my quotation via: E-Mail Fax
Regular Mail
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