Companies We Represent

Your business should be protected from major losses and financial disaster. Please complete the following form so we can better understand your requirements. This will enable us to analyze your business prior to contacting you to determine your insurance needs. 

Request for Business Insurance Quote

Company Name
Your Name
Address
City
State           Zip
County
Home Phone
Work
Fax
E-Mail Address
Age of Insured


Business Information

Type of Business Ownership
Proposed Effective Date: Proposed Expiration Date:
Years in Business:
Indicate Types of Coverages Applicable
    Property
    Glass and Sign
    Valuable Papers
    Crime
    Transportation
    Equipment Floater
    Installation/Builders Risk
    Electronic Data
    Commercial General Liability
    Business Auto
    Truckers
    Garage and Dealers
    Vehicle Schedule
    Boiler and Machinery
    Workers Compensation
    Umbrella

Number of Locations:

Nature of Business (Description of Operations)

Use this area for any special comments or coverages which need special attention.

How Did You Hear About Us?
The McCoy Agency, Inc. © 2007
All Rights Reserved.