Commercial Quote Request

from

Eck Agency, Inc

Insuring What's Important to you!

The following information is necessary for us to help you:

Since each business and insurance situation is unique, a representative will contact you to obtain further information necessary to provide you with an accurate quote 

Products and services offered by the Eck Agency may not be available in all states. This information shall not constitute an offer in any state in which a product or company is not properly registered or licensed. The Eck Agency generally offers and sells its products and services only in the states of Kansas and  Oklahoma. This information shall not constitute an offer in any foreign country.  All quotes are subject to underwriting and may not be available in all states.

Coverage Desired 

(check all that apply)

General Liability

 Employment Practices Liability
Commercial Vehicles  Trucks 
Work Comp Buildings
Business Property   Employee Benefits
Group Health Supplemental
Group Dental Retirement Planning
First Name
Last Name
Title
Business Name
Business type  C-Corp  S-Corp Partnership Sole Proprietor LLC 
Number of Full Time Employees  
Address
City
State   Zip Code
Work Phone
FAX
E-mail
URL (optional)
Nature of Business (what you do)
Best time to contact
Products and services offered by the Eck Agency may not be available in all states. This information shall not constitute an offer in any state in which a product or company is not properly registered or licensed. The Eck Agency generally offers and sells its products and services only in the states of Kansas, Oklahoma, Texas, Missouri, Nebraska, and Colorado. This information shall not constitute an offer in any foreign country.  All quotes are subject to underwriting and may not be available in all states.
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Copyright © 2000 Eck Agency, Inc.  All rights reserved.
Revised: April 29, 2008