Business Name:    
Premises Address:
City:  
GEORGIA
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 
Federal Employer's ID #:
Description of Operations or SIC code:


Number of Employees:              
Payroll (not including owners): $
Estimated Gross Receipts:       $

Select all that apply to your Georgia business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water
Other

Recent Insurance Information:

Current Insurance Company: 
Policy #: Expiration Date: (mm/dd/yyyy)

What types of coverages do you currently have:
Benefit Liability               Business Liability
Commercial Umbrella     Directors & Officers Liability
Discrimination                 Errors & Omissions
Product Liability              Professional Liability
Other

Other Insurance Company Used Within Past 3 Years: 
Policy #:
Losses past 3 years:     Amount paid for each loss: $
Description of losses or loss runs:


Choose Georgia Business Liability Insurance Limits:

General Aggregate Limit (other than products completed)   
Products/Completed Operations Aggregate Limit                
Umbrella Amount:

If you've already filled out information on your buildings or facilities
in another insurance quote form then skip the section below.

Building 1
Building Value: $   Contents Value: $
Total Building Area:        Year Built:
Construction Type:          Sprinklers:
Electrical Type:                             Amps:
Electrical Renovation Year: 
Plumbing Renovation:     Plumbing Renovation Year:
Heating Type:               Heating Renovation Year:   
Roofing Renovation:       Roof Age (years):  
Central Alarm:

List Neighboring Businesses:
To the right:   Distance:
To the left:     Distance:
To the rear:    Distance:

Additional Information or Comments



Click on the "Submit Quote Information" button below to send your
Georgia Business Liability Insurance quote request.

**Information received from this Georgia Business Liability Insurance quote request form sent to JRS Risk Services will be for our use only and will not be sold, given to or distributed to any other parties. A quote will be based on the Georgia business liaiblity insurance information provided and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of insurance. Completion of this form does not entitle your business to a Georgia Business Liability Insurance policy. We are licensed in Georgia and will not provide business liability insurance quotes for other states.


Georgia Business
Liability Insurance Quote
We can provide comprehensive Georgia
Business Liability Insurance coverage services
in the Atlanta, GA area and throughout Georgia!
We are an Atlanta, GA insurance agency offering comprehensive Georgia
business liability insurance quotes to businesses in the following cities and
counties in Georgia: Smyrna, Douglasville, Vinings, Oakdale, Sandy
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Lawrenceville, Forest Hills, Suwanee, Northwoods, East Lake, East Atlanta,
Oakhurst, La Vista, Brookhaven, Doraville, Fulton County, Dekalb County,
Forsyth County, Gwinnett County, Walton County, Newton County, Paulding
County, Douglas County, Cherokee County, and Cobb County, GA. We also
offer experienced Georgia business liability insurance coverage quotes for
businesses throughout the Peach state, including in Macon, Columbus,
Augusta, Athens, and Savannah, GA.
JRS Risk Services of Atlanta,
GA offers comprehensive
commercial insurance coverage
options and experienced
business insurance services
throughout Georgia.
Contact us about Georgia
Business Liability, Commercial
Auto, Business Owners,
Professional Liability, and
Business Property Insurance at
(678) 921-4650.
In addition to Georgia Business
Liability Insurance quotes, we
also offer affordable Business
Owners Insurance quotes.
Georgia Business Information:
JRS Risk Services
2727 Paces Ferry Rd. SE
Building 1, Suite 260
Atlanta, Georgia 30339
Cobb County, GA
Office: (678) 921-4650
Fax: (678) 921-4651
Your Georgia
Business Liability
Insurance Connection
JRS Risk Services
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