Raritan Agency saves money for you on your New Jersey personal and business insurance
Raritan Agency
Insuring New Jersey Residents and Businesses.                 |  Home  |  Email Us  |
754 Route 18, Suite 101
East Brunswick, NJ 08816

   About Raritan Agency    Personal Insurance    Business Insurance    Service   


 
Garage/Auto Repair Shop
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal / Company Data:

Your Name:
Your Company's Name:
Street Address:
City:
State: (Must be New Jersey)
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):
Your Business Type: Corporation
Partnership
Individual
Other

 


Currently Insured?
(If yes, list carrier, and Policy Dates.
If none, type NONE)
 
Current Premium (cost) $
 
List Claims & Amounts Paid
During Last 5 Years
(If none, type NONE)
 
Policy Form:
Claims Made    Occurrence
 
Retroactive Date (if any):
 
Years In Business:
 
DOT Shop Identification
Code(s) Number:
 


 
Underwriting Information:
 
Describe IN DETAIL,
Your Business Operations:
 
Operations Data:
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):
Provide breakdown percentages of work provided:
Passenger %  Truck %  Off-the-Road %
 
Coverage Desired: (Check One Please)
Policy Type I am Interested In:
Claims Made Form
Occurrence Form

Limits of Liability Coverage I am Interested In:
$250,000
$500,000
$1 Million
$5 Million

Limit of business property needed:
$

Limit of Garagekeepers Coverage Needed:
(Total amount of vehicle left in your possession.)
$
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.)
 
 
Send my quotation via: E-Mail Fax
Regular Mail
Please Call by Phone!

 
Thank you for filling out this form COMPLETELY!

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.

Yes, I Agree. Please Send Me a
Garage/Auto Repair Shop Insurance Quote NOW!


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We are Here to Serve You - Find out more about Raritan Agency!

CONTACT US

Raritan Agency, Inc.
754 Route 18, Suite 101
East Brunswick, New Jersey 08816

Phone: (732) 238-6060
Fax: (732) 390-0764

Email Us: info@raritanagency.com
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