Golden Rule Insurance, Osage Beach, MO

Our Other Insurance Products

Click Link for an
On-Line Quote Form

Contractor Liability

Workers Compensation

Garage & Auto Dealers

Tow Truck Insurance

Professional Liability

Directors & Officers

Back To Our Main Page

Questions? E-mail Us At:
debra@goldenruleinsurance.com

On-Line Commercial Restaurant Hotel/Motel Insurance Quote Your Personal Data
Your Name:
Business Name:
Property Address:
City:
*State:
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):

Underwriting Information

Federal Tax ID#: (Some carriers use credit history to qualify, this information is REQUIRED)

Date Coverage Needed:

Prior Carrier:

Describe Business:

Gross Annual Receipts:	$

Describe any liquor sales:

Describe any live entertainment:

Describe food sales:

Gross Annual Payroll:	$

Square Footage of Your Business Location:	$

Type of Buildings and year of construction:	$

If motel or hotel, how many units?

What is average occupancy rate?

Number of Employees:

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

Prior Claims?	Yes No
Describe claims in detail:

Limits & Coverages:

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

Building Coverage Needed?
If so, list type and amount:

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

Don't worry if you are not sure of coverage needed or other information. This preliminary form will allow us to approach the proper carriers and we will get other information from you as needed later.

Comments/Remarks:

Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone

Thank you for filling out this form COMPLETELY!
We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency release this information via the method you have chosen, and to release us any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a Quote NOW!
*Golden Rule Insurance is licensed to sell insurance in many states. If you are contacting us from a state in which we are not licensed, we will contact you to inform you that we cannot provide you with a quote.

Click Button Below When Done

Please Click Only Once!

Golden Rule Insurance Agency, Inc. - PO Box 810, 4065 Hwy 54, Suite One - Osage Beach, MO 65065 -