Please take the time to fill your quote application to the best of your knowledge.  Our staff here at AIE will get back to you ASAP.

YOUR COMPANY NAME (First Named Insured & Other Named Insured)

PHYSICAL ADDRESS (NOT MAILING UNLESS SAME)

PHONE

DESCRIPTION OF BUSINESS

# OF LOSSES IN PAST 5 YEARS

1 2 3 4 5 6 7 8 9 10

TOTAL AMOUNT PAID OUT IN 3 YEARS

$

PROPERTY SECTION:

CONSTRUCTION TYPE

Wood Frame Wood Frame w/ Brick Veneer Solid Brick/Block w/ Wood Roof Solid Brick/Block w/ Steel Roof All Metal Building Other (Describe)

FIRE DEPARTMENT OR DISTRICT

# OF STORES

1 2 3 4 5 6 7 8 9 10

YEAR BUILT

TOTAL AREA

GENERAL LIABILITY SECTION:

GENERAL LIABILITY LIMIT

$1,000,000 $500,000 $300,000

ANNUAL SALES

ANNUAL PAYROLL

BUSINESS AUTO SECTION:

LIABILITY LIMITS

$1,000,000.00 $500,000.00 $300,000.00

VEHICLE DESCRIPTION:

DEDUCTIBLES IF APPLICABLE

WHAT DOES YOUR COMPANY DO?

HOW MANY EMPLOYEES DO YOU HAVE?

Less than 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 more than 30

If more than 30 enter here: 

WHAT IS YOUR ESTIMATED ANNUAL PAYROLL?

$

DO YOU DO WORK IN ANY STATE OTHER THAN ALABAMA?

no yes IF YES WHERE?

TELL US WHEN YOUR CURRENT INSURANCE EXPIRES (OPTIONAL)

I prefer to be contacted by: Email Phone Fax Regular Mail

Thank you for filling out your application, again we will respond with your quote ASAP.