Business Property

Name of Agent Assisting You:*
Name of Business:*
Request Effective Date:*
MM slash DD slash YYYY
No. of Years of Ownership:*
Current Property Carrier:*
Premium Amount on Current Coverage:*
Contact Name:*
Phone Number:*
Contact Email:*
Building Value Business Personal Property Value Business Income (i.e. Estimated Annual Gross Receipts)
Please list any known losses, including the amounts of loss, years of loss, and causes of loss:
Privacy Policy*
- I agree to be contacted by Alera Group in accordance to their Privacy Policy as described below.
By submitting this form, I agree I want to receive additional information from Alera Group, including by email, phone, and mail to the contact information I am submitting. I consent to Alera Group, its subsidiaries, and its service providers, processing my personal information for these purposes and as described in the Privacy Notice. I understand that I can withdraw my consent at any time.
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Building Value	Business Personal Property Value	Business Income (i.e. Estimated Annual Gross Receipts)