Lenox Insurance Group

Call us (815) 212-4812

Business Insurance

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Email Address*

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Preferred form of contact

Email Text Call

Preferred time of contact

Morning Afternoon Evening

Bypass Filling Out Entire Form By Uploading Current Declaration Pages

Business Entity Type:

Sole Proprietorship LLC Corporation Partnership Non-profit Government

Type of Policy:

Business Owner Policy General Liability Workman's Comp Commercial Auto Commercial Property Umbrella Equipment Other

Business Address: Mailing Address: Years in Business: Years in the Industry: Years as a Business Owner: Years insured with current company: Current Insurance Company Name: Business Phone: Business Facts: Website: Secondary Business Phone: Description of Business Operations: Number of Employees: Total Payroll: Percentage of Subcontracted Work:

Certificates Obtained from Subcontractors:

Yes No

Cost of Sublet Work: Gross Revenue/Sales: Additional Insureds: Waiver of Subrogation: Building Value: Contents Value: Improvements:

Type of Coverage:

Basic Broad Special Theft Vandalism Loss of Income

Square Footage:

Updates:

Electrical Plumbing Heating Cooling Roof

Enter Year Updated For Each: Claims: Message

Consumer Report Disclosure

Phone Number
(815) 212-4812
Email Address
michelle@lenoxinsurancegroup.com

Street Address
110 E North St Unit C Manhattan, IL 60442

Business Insurance

Phone Number

Email Address

Street Address