Thank you for your interest choosing Prestige International Insurance Group for you coverage needs. Please fill out the form below so that we may help you find the best coverage.

Business Name :
Owners Name (First & Last) :
Owners Date of Birth :
Business Tax ID / FEIN # :
Email Address :
Phone Number :
Business Street Address :
City :
State :
Zip Code :
Business Type :
Years in Business :
Do You Currently Have Business Liability Insurance? :
When would you like your coverage to start? :
Have you ever had a liability claim? :
How many owners does your business have? :
How many employees do you currently have? :
What are your annual gross receipts?
What is your annual payroll?
What is the square footage of your businesses location (optional)?
How many locations does your business have that require insurance coverage? :
Does your business own/lease any vehicles? :
Does your business own/lease any equipment? :
Does your business maintain an inventory of products/supplies/merchandise? :
Does your business have Workers Compensation Insurance? :