Pavese-McCormick Agency, Inc.
Technology Insurance Services
Phone (732) 247-9800
Fax (732) 828-0061
Click Here to E-Mail Us

Welcome to new-high-tech.com's online inquiry page.

For details on the full range of Pavese-McCormick Agency insurance products, please call us or visit our general website at www.pavesemccormick.com.

Instructions: Complete the following fields and click the submit button to send your inquiry immediately to Pavese-McCormick. All information remains confidential and will be used only for the purpose of developing a prospective insurance program for the business indicated below. Bold text indicates a required field. A confirmation window will appear when your inquiry has been successfully submitted.
General Information
Date: (mm/dd/yy)
 		Date coverage needed: (mm/dd/yy)
Company Name :  
Business Contact Name : Business Contact email :
Address :  
City :
State :
Zip :
Business Phone :
 Business Fax :
Cell Phone :
 Company Website :
Email :
 Referred by :

Liability Coverage
Detailed business Description:

Date Business Established: (mm/dd/yy)
Number of years experienced in field:
Gross revenue:
 Operating costs :

Property Coverage
Total Value of business property

(Desk, Chairs, Phones, Desktop Computers, etc. ):
Value of building
(if owned):

 		Building Construction
(wood, brick & wood, concrete or fire resistive):
Year built:
Number of stories :
Square footage of office:
 Movable business property to be scheduled (Laptops, PDA's, etc.) :

Workers Compensation
Number of employees :
Detailed description of work done by employees:
Annual payroll :

 		Tax/Federal identification number :

Professional Coverage
Yes / No :
 


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