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Product Liability Insurance
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Product Liability Quote Request Form
Please complete and submit this short form and Paul Owens will quickly review and will be in touch with you shortly. Note: We do not work with insurance agents and brokers. We only work directly with product businesses.
Business Name
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Contact Name
*
First
Last
Title
Email
*
Phone
*
Website
Type of products you sell:
*
Are you a start up?
*
Yes
No
Is your product already on the market?
*
Yes
No
If no, have you developed instructions and warnings?
*
Yes
No
What are your projected 12 month gross sales estimates?
*
Do you currently have insurance?
*
Yes
No
If yes, what is your renewal date?
*
MM slash DD slash YYYY
Select which desciptions apply to your operations (you can choose more than one)
*
Manufacturer
Wholesaler
Retailer
Inventor
Installer
Importer
Exporter
Why do you want to carry insurance (you can choose more than one)
*
Satisfy contract requirements
Protect myself
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