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More About Our Agency

Shaw-Day Insurance
Agency, LLC

1700 E. Prien Lake Rd.
Suite 1
Lake Charles, LA 70601
(Click for Office Map/Directions)
 
E-Mail:
quotes@louisiana-auto-
insurance-quote.com

Local Phone:
337-474-0006

Fax:
337-474-0008


Visit Our Agency's Other On-Line Quote Forms and Start Saving!
 
Auto Insurance Quote

Home Insurance Quote

Flood Insurance Quote

Motorcyle Ins. Quote

R.V. Insurance Quote

Boat Insurance Quote

Renters Quote

Life Insurance Quote

Cancer Insurance Quote

Businessowners Quote

Commercial Auto Quote

Group Benefits Quote

About Our Agency

Office Map/Directions

Policy Service Request

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Louisiana-Auto-Insurance-Quote.com - Louisiana car insurance discounts
 
On-Line Businessowners
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal and Company Data:

Your Name:
Your Company's Name:
Street Address:
City:
State: (Must be Louisiana)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 


Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type NONE)
 
Type of Business:
Retail    Wholesale
Office    Other
 
List Claims & Amounts Paid
(If none, type NONE)
 
Years In Business:
 
Business type:
(proprietorship, corporation, etc.)
 
Describe Business in detail:
(i.e., Delicatessen and sandwich shop, etc.)
 
 


 
Underwriting Information:
 
Describe IN DETAIL,
Your Business Operations:
 
Ownership & Payroll Data:
List Employee's Annual Payroll Here (if none, enter $0): $ Insert # of
Employees here:
 
Location & Sales Information:
Insert Annual Gross Revenues from this operation here: $ Square Footage of office or business location:
 
Type of Building (wood frame, concrete, etc.): Number of Stories:
 
Are there other business/residences in this building (describe)?: Describe safety features (alarm, sprinklers, fire protection, etc):
 
Coverage Desired: (Check One Please)
The Coverage I Am Looking For:

Liability Only
Liability & Business Contents
Liability, Building & Contents Coverage
A Package Policy Including the Above,
        Plus Miscellaneous Coverages

NOTE: Don't worry if you are not exactly sure about coverage type... we will suggest the best coverage for you - just try to tell us what you are looking for! (If we need more info. we will let you know.)
 
Liability Coverage:
($300,000, $500,000, $1 Million, etc.)
$
 
Business Contents Coverage:
(The amount of your personal business property)
$
 
Building Coverage:
(The amount of building coverage if you own your bldg.)
$
 
Miscellaneous Coverage:
(List any special coverage peculiar to your business, such as Garagekeepers Legal, Loss of Earnings, Valuable Papers, etc.)
$
 
Other Coverages You Would Like Information On: Commercial Vehicle
Bonds, License/Performance
Workers Compensation
Builders Risk Insurance Commercial Umbrella
 
 
Send my quotation via: E-Mail Fax
Regular Mail
Please Call by Phone!

 
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We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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