Kauger Insurance Group Inc.

Kauger Insurance Group, Inc. 100 South Main Street, Baxley, Georgia 31513 Phone: (912) 367-3566 Fax: (912) 367-3491 Toll Free: (800) 823-3931

BUSINESS INSURANCE QUOTE

Contact Information
Name
Address
City
State
Zip
Phone
Email
Best time to call	AM PM

Operation Information

Description of Operation:

Annual Receipts.................
Annual Payroll....................
Number of Owners, Partners or Officers......
Number of Full Time Employees................
Number of Part Time Employees................

Location of Business:

Address......
City.............
State
Zip
Business Occupancy....... Office or Storage
Construction.................... Frame or Masonry
Value of Building (if owned).....
Value of Contents..................
Value of Tools & Equipment....

Loss History (List all losses in last three years)

Select if none
Date........Description.........Amount

Have you had previous insurance?

Yes No
If yes, how many years?.........
When does it expire?..............

Comments

Please Note: Insurance coverage cannot be bound without a written binder from our office.

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