Hollingsworth Insurance Services

Artisan Contractor
Quick Quote
Insurance Application
     We would like to provide you with a free, no-obligation artisan contractor insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Agent Information
Agent Name:
Phone #:   Fax #:
Email Address:
  (Note: A copy of this submision will be sent to the email
  address entered in this field, so please enter correctly)

General Information
Name Insured(s):
City: State: Zip:
Insured Telephone:

Risk Information
What does the risk do?:
Number of owners/partners:
Number of: Full time employees:   Part time employees:
Employee Payroll
Annual Gross Receipts
Sub-Contracting Costs
Number of years experience in this field:
Business Status:

Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough fields above, please enter them here.

Please click on the "Submit Application" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.


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