Washington insurance quotes from Basin Insurance
Reducing Insurance Costs for Washington Residents and Businesses!
Personal Auto, Homeowners Insurance from Basin Insurance
Personal Auto, Homeowners Insurance from Basin Insurance
Homeowners Insurance

Personal Auto Insurance

Motorcycle Insurance

Boat Insurance

Antique Auto Insurance

Commercial and Business Insurance from Basin Insurance
Apartments/Rental Program

Businessowners Insurance

Contractor Liability Program

Church Insurance Program


life and health Insurance Products from Basin Insurance

Life Insurance

Health Insurance

Annuities


Other Insurance Services from Basin Insurance
Service My Account

More About Our Agency

Office Map/Directions

Questions? E-Mail Us!

Return to Home Page

 
 
On-Line Church
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal / Company Data:

Your Name:
Your Church/Organization's Name:
Street Address:
City:
State:
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:
(Describe coverage or values in remarks if needed)
Pastoral Counselling Liability
Musical Instrument Coverage
Pipe Organ Coverage
Stained Glass Coverage
Pastoral Personal Property
Law & Ordinance Coverage
Demolition & Debris Removal
 
Comments, Remarks, &
Additional Coverages
Description:
 
 
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
Church Policy Quote NOW!

Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

Basin Insurance Associates, Inc . 17416 E. Sprague Avenue . Spokane Valley, WA 99016
Phone: 1-509-340-3739 | Fax: 1-509-242-8569 | E-Mail us at: tbrown@basininsurance.com
Our Telephone Quoting Hours are: 9:00am to 4:00pm (Monday-Friday)
View Our Privacy Notice | Website Design © 2008, Insurance Web Sales