In addition to Liability
Insurance for your New
Jersey business, we also
offer affordable Employee
Health Insurance plan
premiums or choose another
NJ business insurance
coverage from the list below.
**Information received from this New Jersey Business Liability Insurance quote
request form sent to American Insurance Services Agency will be for our use only
and will not be sold, given to or distributed to any other parties. A quote will be based
on the business liability insurance plan information provided and does not guarantee
acceptance of the risk by us. The precise coverage afforded is subject to meeting
underwriting guidelines, and the terms, conditions and exclusions of the policy as
issued. By submitting this request you acknowledge that this is neither an offer to
insure nor a guarantee of insurance. Completion of this form does not entitle you
to a New Jersey Business Liability Insurance Plan Policy. We are licensed in New Jersey
and will not provide quotes for other states.
"Your New Jersey Business Liability Insurance Agent!"
We also offer affordable business liability insurance premiums to businesses in the
following New Jersey counties and cities: Union County, Essex County, Bergen County,
Passaic County, Sussex County, Morris County, Warren County, Hunterdon County,
Somerset County, Middlesex County, Monmouth County, Mercer County, Burlington
County, Clark, Newark, Jersey City, Elizabeth, Rahway, Colonia, Iselin, Avenel,
Woodbridge, Port Reading, Carteret, Perth Amboy, Fords, South Amboy, Metuchen,
Plainfield, Dunellen, South Plainfield, Green Brook, Fanwood, North Plainfield,
Cranford, Scotch Plains, Westfield, Union, Millburn, Springfield, Mountainside, Gillette,
Warren, Watchung, Stirling, Millington, Middlesex, Martinsville, Piscataway, Edison,
New Brunswick, Highland Park, North Brunswick, Sayreville, East Brunswick,
Somerset, Milltown, South River, Bound Brook, Somerville, Bridgewater, Bayonne,
Linden, Roselle, Hoboken, Union City, Weehawken, West New York, Guttenberg,
Cliffside Park, Edgewater, North Bergen, Secaucus, Fairview, Ridgefield, Fort Lee,
Leonia, Palisades Park, Englewood Cliffs, Englewood, Bergenfield, Teaneck, Paramus,
Bogota, Ridgefield Park, Little Ferry, Hackensack, Maywood, Teterboro, South
Hackensack, Rochelle Park, Moonache, Lodi, Hasbrouck Heights, Saddle Brook,
Garfield, Elmwood Park, Woodridge, Carlstadt, East Rutherford, Lyndhurst, Rutherford,
Wallington, Passaic, Clifton, Paterson, Totowa, West Paterson, Little Falls, Great Notch,
North Caldwell, Cedar Grove, Verona, Montclair, Bloomfield, West Orange, Glen Ridge,
Belleville, Nutley, Kingsland, North Arlington, Kearney, Harrison, East Orange, East
Newark, Orange, Irvington, South Orange, Hillside, Townley, Livingston, Wayne,
Trenton, Camden, Atlantic City, Princeton, Vineland, Willingboro, and Toms River, NJ.
Business Name:    
Premises Address:
City:     State:     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 
Federal Employer's ID #:
Description of Operations or SIC code:


# of full-time employees:    # of part-time employees:
# of locations:    Estimated Annual Payroll: $
Gross Sales:$

Select all that apply to your New Jersey business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water
Other



Current Insurance Company: 
Policy #: Expiration Date: (mm/dd/yyyy)
What types of coverages do you currently have:
Benefit Liability               Business Liability
Commercial Umbrella     Directors & Officers Liability
Discrimination                 Errors & Omissions
Product Liability              Professional Liability
Other

Other Insurance Company Used Within Past 3 Years: 
Policy #:
Losses past 3 years:
Description of losses or loss runs:



General Aggregate Limit (other than products completed)   
Products/Completed Operations Aggregate Limit                
Umbrella Amount:



Building 1
Building Value: $   Contents Value: $
Total Building Area:        Year Built:
Construction Type:      Sprinklers:
Central Alarm:
List Neighboring Businesses:
To the right:   Distance:
To the left:     Distance:
To the rear:    Distance:

Building 2
Building Value: $   Contents Value: $
Total Building Area:        Year Built:
Construction Type:      Sprinklers:
Central Alarm:
List Neighboring Businesses:
To the right:   Distance:
To the left:     Distance:
To the rear:    Distance:

Additional Information or Comments


Click on the "Submit Quote Information" button below to send your
New Jersey Business Liability Insurance quote request.


Choose New Jersey Business Liability Insurance Limits:
New Jersey Business Information:
Recent Insurance Information:
If you've already filled out information on your buildings or facilities
in another insurance quote form then skip the section below.
New Jersey
Business Liability
Insurance Quote
Request information about disability insurance for your New Jersey business.
We provide affordable Business Liability Insurance coverage's throughout New Jersey!
Do you have questions about
business liability insurance?
Copyright 2004-2008 American Insurance Services Agency - All rights reserved
Business Insurance
Quotes
Liability Insurance
Quote
American Insurance
Services Agency
1129 Raritan Road
Clark, New Jersey 07066
(732) 680-4444
Fax: (732) 680-4067
"We're Your New Jersey
Commercial Liability
Insurance Agent"