Talk To Us, Before You Buy!
 
Location: 308 8th Street, Hoboken, NJ 07030
Fax: 201-459-0199 • E-mail: alknoblauch@optonline.net
 
Call Us Anytime: 201-459-1300

Business Owner's Plan/General Liability Quote Request Form
Please Complete to Receive a Quote
Company Name
Address
Bold = Required field
Other Locations?
Contact Name
Website?
Email:
Telephone Number:
Fax Number:
What Does Your Company Do?
Number of Employees:
Specific Duties of Employees:
Estimated Monthly Payroll
Estimated Monthly Receipts
Rent or Own your building / Space / office Label
If you own, what is the estimated value of the building?
How Many Square Feet (approximate)
Sprinklers
Type of Building? (Wood, Masonry, Steel) please describe
Do other Tenants Share Your building?
If so, list the types of businesses that share your building
Do you carry or warehouse any stock or merchandise? If yes describe?
Estimate Value of stock/merchandise; give fluctuation at any given time
Any Prior Claims? If so describe?
Who is your current carrier?
What is your current premium?
When is your renewal?
$ Amount of current General Labiality
$ Amount of General Labiality desired?
Estimate $ amount of business property if you suffered a total loss? (desks, computers, phones?)
Any Commercial Vehicles
How Many?
List types of vehicles
Names, age & diver's licenses #'s of any and all drivers
Who are the primary Drivers?
Comments / Requests

Request a Quote

Health Insurance Census Form (Quote Request)
Please Complete to Receive a Quote
 
* It always helps to fax over a copy of your current health insurance renewal, along with this form. This will allow our agents to complete a plan comparison report for your company.
Company Name
Contact Name
Zip Code
E-mail Address
Phone
Fax
Bold = Required field

List employees:  1st Name, age, sex and family status (single, husband / wife, family, parent / child(ren)) 

Employee 1
Age
Sex
Family Status
If you have more employees please fax a census to 201-459-0199 or email to alknoblauch@optonline.net 
Family Status
Sex
Age
Employee 2
Employee 3
Age
Sex
Family Status
Family Status
Sex
Age
Employee 4
Employee 5
Age
Sex
Family Status
Life Insurance Quote Request Form 
First Name
M.I.
Last Name
Address Line 1
City
State
Zip Code
Country
Age
Gender
Bold = Required field
Height:
Weight:
Nicotine Use:
Last used?
Email:
Telephone Number:
Fax Number:
Job Occupation/Title/Short description Annual Salary
Face Amount/ Death Benefit
250K
500K
1 million
2 million
5 million
Other Amount
Insurance Purpose:
Other
Business: Key Man, Buy/Sell Agreement

Type of Insurance Requested:
Describe Your General Health
Diabetes
Has your diver licenses been revoked or suspended in the last 5 years? If so describe situation and list your license number
Comments / Requests

Home Owner's Insurance Quote Request Form
If it's possible you can, please email a picture of the home to ALKNOBLAUCH@optonline.net

Name
Birth Date
Address To Be Insured
City
State
Zip Code
Country
E-mail Address
Phone
Fax
Bold = Required field
What date do you need to be insured by (closing date)?
Your renewal Date
Square feet
Garage?
# of cars
Detached / Attached
Purchase Price?
Mortgage Amount
Any Loss/ claim History
When?
If yes, please describe
Approximate the value of all your belongings? (exclude jewelry)
Are there any rings or jewelry to be insured?
Please list
Approximate Value of all jewelry?
When was home Built (apprx)
What type of construction is the building? (Wood frame. Brick? Siding)
What Type of Heat
Oil Tank, Age
Oil Tank Located inside/outside (exactly where)
Is there a Pool?
In ground/ above ground?
Fence
Diving Board
Updates
Electrical
Plumbing
Roof
Distance between Houses
Dogs?
How Many?
Breed?
Age
Training
Bite History
Do you need Flood Insurance (home owners insurance will not cover flood by itself)?
In the event you are sued, what is the limit of liability coverage you would like:
Other
Drivers License Number (s)
State of Issue
Comments / Requests
Condo Insurance Quote Request Form
Name
Birth Date
Bold = Required field
Telephone Number
Fax Number
E-mail Address
Country
Zip Code
State
City
Address To Be Insured
What date do you need to be insured by?
Your Renewal Date
Square Feet
Purchase Price?
Mortgage Amount
Any Loss/Claim History
When?
If yes, please describe
Approximate the value of all your belongings (exclude jewelry, cars)
Are there any rings or jewelry to be insured?
Please list
Approximate Value of All Jewelry?
When was Condo Built (apprx)
How Many Units in Building?
What type of construction is the building?
Are there Sprinklers?
What Type of Heat
Any Yard Space?
If so Square Feet
Is there a Deck?
Dogs? List how many and what breed?
Any Biting History
Trained
Do you need Flood Insurance (condo insurance will no cover flood by itself)?
In the event you are sued, what is the limit of liability coverage you would like?
Other Amount
Drivers License Number(s)
State of Issue
If it's possible, please e-mail a picture if the building and unit to alknoblauch@optonline.net.
Comments / Requests
Unit

Retirement Income Insurance

Complete the Information below to find out what your monthly Payments for life will be, if you decide to purchase this product.

Bold = Required field
Name
Age
Sex
Male
Female
Married
Yes
No
Approximate Amount of 401K Savings
Year You Plan to Retire
Amount You Wish to Annuitize
Company Name
Email

This product is Perfect for professionals nearing retirement.  If you are a large group, please call us about offering this product to your empoyees along with the MetLife’s Personal Pension Builder . Please see links below for more info. 

Met Life PPBVB Rate Sheet          PersonalPenBuilderSS          RII First Sale

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