Voice: 334-792-5101
Fax: 334-792-4552
SLINGLUFF UNITED INSURANCE
P.O. Box 6947
568 South Oates Street
Dothan, Alabama 36301
Artisan Contractor Quote Request

Complete the following information if you would like to obtain a quote. Please understand this is not an application. An application will be sent to you if coverage is desired.

All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.

Personal Information
First Name:
Last Name :
Business Name :
Street Address:
City:
State:
Zip Code:
Phone Number:
Alternate Telephone:
Email Address:
Referred By:
Underwriting Information
Number of owners
Number of Employees
Payroll of Owners
Payroll of Employees
Total annual gross receipts
Total annual sub costs
Contractors License Number
Date of Birth:
Years of experience
Years operated under current name
Other business names Yes No
Have you been involved in the original construction or remodeling of town homes, condos, row homes or developments of 15 or more unattached single family dwellings during the past 5 years? Yes No
Do you construct footings or foundations which may support dwellings or other structures? Yes No
Do you construct slab or monolithic floors? Yes No
Do you construct piers or underpinning which may support dwellings or other structures? YesNo
Do you construct retaining walls which may support dwellings or other structures? Yes No
What is the percentage of work done as a General Contractor?
What is the percentage of work done as a Sub-Contractor?
What is the percentage of work done on Residential?
What is the percentage of work done on Commercial?
What is the percentage of work done for Remodeling?
What is the percentage of work done for Renovation?
What is the percentage of work done for Repair or Maintenance?
Claims Information
Were there any losses or claims in the last 5 years? Yes No
If yes, what is the date, amount paid and description of each loss or claim?
Coverage Information
Current Insurance Company
How much are you paying now?
What is the liability limit requested?
What is the loss of income requested?
Questions or Comments
Best Time To Contact You
Please let us know the best time to call and discuss your quote.    Morning      Afternoon  
   Evening       Anytime
Or Specify Other:
 
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