ROBERT HASHIM
INSURANCE SERVICES

 

Business Insurance Quote Request

This is the first step in the quoting process.  Tell us a little about your Business.  If you're just starting out, give us good estimates of what you expect.  We will contact you.

 Name  
 Business Name  
 Street Address  
 Street Address  
 City, State, Zip  
 Phone Numbers   Voice     Fax   
 Email Address  
 Business Activities
 1. Type of organization  
 2. How many owners, partners, or officers?  
 3. How many employees, excluding owners,
     partners or officers?
 
 4. How many years have you been in business?  
 5. Last year's payroll:  
 6. This year's projected payroll:  
 7. Last year's gross sales:  
 8. This year's projected sales:  
 9. Describe your normal business activities

   
 10. Have you had losses or claims in the past 5
     years?
 
     If yes, please give description, date and amount paid for each

   
 Coverage Selection
 Please indicate the coverage you would like quoted.
  Property   Workers' Comp
  General Liability   Professional Liability
  D & O, Employment Practices Liab.   Commercial Auto
  Umbrella Liability   Auto Dealers/Garages/Valet Parking
 Remarks

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PROFESSIONAL RISK MANAGEMENT SINCE 1975

14462 Ipava Dr

Poway, CA 92064

Phone 858-679-1507

Fax 858-679-1230

License #0C17040

Copyright 2007 Robert Hashim Insurance Services. All rights reserved.