Name: Intermarket Insurance Agency
Address: 205 East Main St, Huntington, NY, 11743, US
Telephone: (631) 421-2424

Company Legal Name
DBA
Name
First Last
Location Address
Street Address Address Line 2 City State ZIP Code
Do you have a separate mailing address?
- Yes
- No
Mailing Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Fax
Gross Annual Sales
Desired Effective Date
MM slash DD slash YYYY
Are you currently insured?
- Yes
- No
If Yes:
Current policy expiration Date
MM slash DD slash YYYY
Current Carrier
If you need PROPERTY coverage for your office - How much?
Business Property Limit:
Property deductible desired:
Do you have a commercial auto policy in place?
Property Questions
Square footage:
Is there an alarm?
- Yes
- No
If yes, where is the central station?
Sprinklers?
- Yes
- No
Year Built:
Roof updated (year):
Electrical updated (year):
Amount of business personal property:
Value of improvements and betterments to you space (cost to return your space to like and kid if there was a loss):
Warranty*
- I hereby WARRANTY the above information to be true
Quotes generally take 2-3 business days to turn around. If you are up against a district deadline and need this sooner please provide us with the deadline date.
Deadline Date
Comments
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Real Estate Liability and Property Quote

Property Questions