Commercial Liability Rate Quote Request

We Serve:

Washington: 206-859-4894

Oregon: 503-445-4947

STOP! Our internet customers can go to the front of the line!

Vern Fonk Insurance gives our internet customers special attention by sending them to the front of the line. Please call during business hours: 9 am - 6 pm, Monday through Friday and 9 am - 2 pm on Saturday for immediate assistance on your business insurance needs.

Washington State clients, please call our Washington Commercial Department at 206-859-4894. Oregon clients, please call our Oregon Commercial Department at 503-445-4947.

Internet customers only!

Please fill out the form below and we will contact you with an insurance quote and answer any questions you have. Required fields are marked with a * , however to receive the most accurate quote we prefer that you answer all the questions.

Tell Us About Yourself
*First Name:
Middle Initial:
*Last Name:
*Name of business:
*Type of business:
*Federal Employer Identification Number:
*Address:
*City:
*State:
*Zip:
*Day Phone:	– ext.
Cell Phone:	– ext.
*Email:

How did you hear about us?
*How did you hear about us?

Contact Options
*How should we reach you?	Day Phone Cell Phone
What's the best time to reach you between 9am and 6pm?

Customer Information
*Annual Payroll:
*Number of employees:
*Prior year gross receipts:
*Prior year payroll:
*Does the applicant use subcontractors?:	Yes No

Risk Assessment
*Do or have past, present or discontinued operations involve(d) storing, treating, discharging, applying, disposing, or transporting of hazardous material? ( e.g. landfills, wastes, fuel tanks, etc):	Yes No
*Have any operations been sold, aquired or discounted in the last 5 years?:	Yes No
*Have any crimes occured or been attempted on your premises within the last 3 years?	Yes No
*Has the applicant ever or will the applicant perform handyman work or offer other services, such as lawn mowing or snow blowing?:	Yes No
*Has the applicant ever or will the applicant construct room additions?:	Yes No
*Has the applicant ever or will the applicant engage in plumbing, concrete, electrical, demolition, trenching or other work outside of carpentry construction work?:	Yes No
*Describe your last 3 jobs:

Eligibilty Information
*Nature of Business:
*Legal entity of applicant:
*Years in business under current ownership:
*Years of management experience in this field:
*Describe management experience in this field:
*Prior insurance carrier:
*Number of property losses in the last 3 years: