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No Obligation
Business Insurance Quote Request

** ILLINOIS and INDIANA Business ONLY **

For your free, personalized, no-obligation insurance quote, please complete the form below. In order to provide you with the most accurate quote as possible, please provide as much information as possible. This information will be kept fully confidential and will be used for quoting purposes only.

Red Identifiers Indicate A Required Field
General Information
Business Name:
Contact Name:
Address:
City: State:
Zip:
Phone:
FAX:
Best Time To Call: AM PM

E-mail Address:


Current Insurance Information
Company Name:

Policy Expiration:

Premium Amount:
Please List Current Coverage Types
Bond
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
 Disability
Group Health
Group Life
Professional Liability
Workers' Compensation
Other  
About Your Business
# of full-time
employees		 # of part-time
employees		 How long
in business
years
How many
locations		 Annual
sales
$
Please give a brief description of your business and clientele (below):

Coverage Desired
Please List Desired Coverage Types
Bond
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
 Disability
Group Health
Group Life
Professional Liability
Workers' Compensation
Other  
Additional Comments
Please leave any comments or additional entries here.

Click "Submit Request" to send your quote request.

We will respond to you as soon as possible.
Thank you for giving us the opportunity to serve you.
Abel and Associates Insurance, Inc. Phone (219) 583-9249
614 N. Main Street
PO Box 601		 (800) 645-2419
FAX: (219) 583-8097
Monticello, IN www.abelinsurance.com

E-mail: abelins@abelinsurance.com
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