Please complete the following BOP quote form and submit for a comprehensive analysis of plans and rates that are available to you at this time.  A Buffalo Insurance Business specialist will contact you after the submission has been made.

Per Our Privacy Policy, we will never sell  your personal information to a third party. All information is confidential and for the sole use of Buffalo Insurance to provide your quote.

BUSINESS OWNERS POLICY (BOP)
Agent Preference or Agent you are currently working with: * JD Buffalo Have not talked with an agent yet
BUSINESS INFORMATION
Insured Name	*
Contact Number:	*
Email Address:	*
Business Legal Name:	*
Business Tax ID:
Business Website:
STREET ADDRESS:	*
CITY:	*
STATE:	*	AR OK TX TN
ZIP	*
BUSINESS MODEL
Type of Business:	*
Legal Entity (LLC? Corp? Partnership?):	*
Years In Business:	*
Years of Management Experience:
Describe all the services provided by your business:	*
Hours of Operation:
ANNUAL SALES $	*
Is your loss ratio or shrinkage (average annual losses/quoted premium) less than 40%?	*	YES NO
BUSINESS ASSETS
Does the business own any company or commercial vehicles?		YES NO
If YES, how many?
Vehicle Descriptions:
Does Business have multiple locations?	*	YES NO
Notice: For Businesses with multiple locations, we will have to eventually gather the specs below for each location.
Building / Property Owned or Leased?	*	OWNED LEASED
Value $ *
Year Building Built:	*
Type of Construction:
Number of Stories:	*
Square Footage:	*
Burglar Alarms Active?	*	YES NO
Fire Alarms Active?	*	YES NO
BUSINESS EMPLOYEES
Number of Full Time Employees:	*
Number of Part Time Employees:	*
Do You Use Temp Employees?	*	YES NO
Do You Use Sub-Contractors?	*	YES NO
ANNUAL PAYROLL $	*
CURRENT COVERAGE / COVERAGE NEEDS
Current Insurer Carrier:	*
Desired/Renewal Premium:
Liability Limits Desired: * 300K 500K 1Million
Any outstanding suits or liens against the business and/or any bankruptcies last 3 years?	*	YES NO
If YES, Please Explain:
HOW ELSE CAN WE HELP YOU TODAY?
Some of our clients have saved over 20% on their auto and home insurance by letting us shop for a better rate.
Would you like to see if we can save you money on your AUTO INSURANCE? * YES NO
Would you like to see if we can save you money on your HOME INSURANCE? * YES NO
Are you interested in GROUP HEALTH INSURANCE? * YES NO
Are you interested in INDIVIDUAL HEALTH OR LIFE Insurance? * YES NO
Are you interested in Supplemental Policies for added coverage for CANCER or DISABILITY Insurance? * YES NO
REQUIRED. By checking this box, I understand that the Information provided above (and, possibly, additional information) to be used to get non-binding pricing indication. * I AGREE I DO NOT AGREE
Security Code	*