Business Insurance Quote Form

Fields with an asterisk (*) indicate a required field. Make sure to press the "SUBMIT" button at the bottom of the page when finished.

Questions? Call an AmeriProtect representative at 517.619.1290.

Contact Information:

Doctor's First Name:*

Last Name:*

Practice Name:

Federal ID Number (FEIN):

Email:*

Phone Number:

Street Address:

Practice/Business Address

City:

State:

ZIP:

*Note: We will not share your email address with anyone. It is simply being collected to communicated information regarding this application as well as other AmeriProtect information.

Quote Selection:

Select the product(s) for a quote:

Business Owner's Policy (property & liability)

Workers' Compensation Coverage (required in most states)

Group Life Insurance

Data Breach Protection (recommended)

Credit Card Processing

Other (business auto, flood, etc.)

Walk me through these options

Additional information or comments:

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