» Commercial

Commercial

All information submitted to us via this website or via e-mail will be used exclusively by the Lackey Insurance Agency, LLC and our insurance carriers in order to provide quotes or service. We will NOT provide your information, including e-mail addresses, to any other company or service for any other reason, and we will not use any information you provide in our other marketing programs.

This form will be emailed to our office. The red * means that this information field has to be filled out!

Important – Commercial Quotes only for the states of Oregon and Washington!

Business Owners

* Business Name

* Contact Name

* Address

* City

* State

* Zip Code

* Home Phone Number

* Work Phone Number

* Cell Phone Number

* Fax Number

* Email

Business Information

* Type of Business

* Number of Owners/Partners

* Number of Full Time Employees

* Number of Part Time Employees

Number of Years in Business

If Startup, Number of Years in Industry

Insurance Information

* Do You Currently Have Insurance? Yes
No

If yes, with which insurance company?

When does current policy expire?

Annual Premium

List any losses/claims in past 3 years

Type of Insurance Interested in receiving a quote for

Property

General Liability

Business Auto

Workers' Compensation

Professional Liability

Tools & Equipment

Errors & Omissions Coverage

Additional Comments

Questions or Comments

As every type of business requires specialized information to provide you with a quotation, you will be contacted by one of our agents

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