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Great Northern Insurance Agency
Our Dedication Ensures Your Satisfaction

CALL NOW 248-856-9000

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Contact Us

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Calculators
Contact Us

Business Owners Quote

Our process is transparent

For Help Call 1-(248)-856-9000

GENERAL INFORMATION

Fields marked (*) are mandatory

NAME OF INSURED

ADDRESS

CITY

STATE

BUSINESS PHONE

FAX NUMBER

E-MAIL ADDRESS

LOCATION ADDRESS (TYPE 'SAME' IF SAME AS ABOVE)

ZIP CODE

FEIN

PROPERTY QUESTIONS

AGE OF BUILDING/YEAR BUILT

TYPE OF BUILDING

NUMBER OF STORIES

OTHER OCCUPANCIES

SQUARE FEET YOU OCCUPY (SQ. FT.)

If the building is over 25 years old, please answer the follwing

Fields marked (*) are mandatory

YEAR ELECTRICITY WAS UPDATED

IS IT ON CIRCUIT BREAKERS?

Yes No

YEAR PLUMBING WAS UPDATED

COPPER OR GALVANIZED PLUMBING?

Copper Galvanized Other

IF OTHER

YEAR BUILDING WAS LAST RE-ROOFED

TYPE OF ROOFING MATERIAL

TYPE OF HEATING SYSTEM IN THE BUILDING

PROTECTIVE DEVICES

BURGLAR ALARM

Yes No

CENTRAL STATION OR LOCAL ALARM?

Central Station Local Alarm

NAME OF ALARM COMPANY

IS THE BUILDING SPRINKLERED

Yes No

ARE THERE SMOKE DETECTORS

Yes No

LIABILITY QUESTIONS

Please provide information on previous insurance carrier

PREVIOUS INS. CARRIER

POLICY NUMBER

PRIOR PREMIUM

POLICY RENEWAL DATE

Please provide information about your business

YEARS IN BUSINESS

PROJECTED GROSS ANNUAL RECEIPTS

PROJECTED ANNUAL PAYROLL

DESCRIBE YOUR BUSINESS, PRODUCT OR SERVICE

COVERAGE LIMITS

BUILDING

CONTENTS (EQUIPMENT, INVENTORY, SUPPLIES, ETC.)

DEDUCTIBLE

LOSS OF INCOME

MONEY AND SECURITIES

GLASS OR SIGNS

NON-OWNED AND HIRED AUTOMOBILE LIABILITY

IS LIQUOR LIABILITY NEEDED?

Yes No

IF GLASS COVERAGE IS NEEDED, PLEASE PROVIDE DIMENSIONS

PLEASE LIST OTHER COVERAGES YOU MAY NEED

MISCELLANEOUS INFORMATIOIN

NAME OF ADDITIONAL INSURED (LANDLORD OR VENDOR)

MAILING ADDRESS

CITY

STATE

ZIP

ADDITIONAL COMMENTS

ADDITIONAL COMMENTS

Products

Services

Locations

Products

Auto Quote
Homeowners Quote
Condominium insurance
Renters Insurance
Commercial Auto
Business Owners (BOP)
General Liability
Inland Marine
Liquor Liability

Services

Change Address
Add Vehicle
Delete Vehicle
Change Vehicle
Add Driver
Delete Driver
General Auto Request
File Auto Claim
General Home Request
File Property Loss

Locations

Main Office
ISU-Great Northern Insurance Agency 39850 Van Dyke Ave Sterling Heights , MI 48313
Phone:248-856-9000
Fax:248-856-9001
California Office
Kevin Lam 1900 Camden Ave San Jose, CA 95124
Phone:(408) 444-5196
Fax:(877) 275-1639
Ann Arbor Office
Kristine Reed PO Box 3306 Ann Arbor, MI 48106
Phone:(734)945-0027
Phone2:(248)856-9000
Fax:(248)856-9001

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