Let's Get Started....  You Have a Few Options.

Contact us today for a free policy review.

To get started immediately, complete the form to the right and click SUBMIT. Or Click Here to download a fillable PDF version of our Commercial Insurance Questionnaire. 

Our specialists will walk you through the process of shopping for insurance and help you save money without leaving you unprotected.

You can also call us, e-mail us, or send a fax.

Toll Free 1-800-476-1070

California (818) 322-3700
Colorado (303) 278-2278

Fax: (800) 328-1070

Email: info@myavantiservices.com

California License Number 0H8535

Or, message us with your contact information below
and we'll call to talk you through the quoting process. 

 Commercial Insurance Questionnaire

Please complete the information below. IMPORTANT: This form is not an insurance policy – it asks for general information necessary to prepare a quotation. Note that many carriers require a complete signed carrier application specific to their product offerings.

GENERAL INFORMATION

Insurance Coverage Requested (Check all that apply):







PROPERTY DETAILS

Please provide the following building information:

Building Security Information:

Property Value Information:

GENERAL LIABILITY

PROFESSIONAL LIABILITY

ALLIED MEDICAL AND MEDICAL PROFESSIONAL LIABILITY

WORKERS' COMPENSATION

Number of employees:

ADDITIONAL COVERAGE INTERESTS

Select all that apply:











We'll get started on your request right away.