Commercial Quote

Action Insurance Group will need to review your specific needs for Commercial/Life/Group Bnenefits. Please complete the request for quote (response within 24hrs), email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call 403-457-1000 or Toll-free 1-866-457-4555.

Company Name (*)
Require Company Name
Street Address
Address
Mailing Address
Mailing Address Required
City (*)
City Name Required
Province (*)
Province Required
Postal Code (*)
Postal Code Required
Primary Contact (*)
Primary Contact Required
Position (*)
Position Required
Are you the dicision maker for insurance (*)
Decision Maker field required
Phone (*)
Phone Number Required
Fax
Fax Number Required
Email (*)
Email Address Required
Describe the operations of your organization (i.e. breakdown of revenue by source etc.)
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Years In Business (*)
Number of years In business required
Number of Employees (*)
Number of Employees Required
Gross Revenue (*)
Gross Revenue Required
Any sales to US or other contries? (*)
Required response on "Any sales to US or other countries?"
If Yes, % of sales
Percent of Sales required
Current Insurer
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Premiums
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What do you need insured? (*)
Required: "What do you need insured?"
Liability(Damage to property of others or injury to others) (*)
Liability Amount Required
Automobile: List all vehicles by make and year and the purpose / where it is driven
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Other Coverage: List other coverages required such as Bsiness Interruption, boiler & Machinery, Crime, Motor Truck Cargo, Property of Others etc. (This is only a few of the coverages available)
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List all claims in the past 5 years
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Other info we should know about you and your organization that would e important to placing insurance or to servicing you in the best way possible?
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