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Texas insurance from The Superior Insurance Agency
Superior Insurance Services - Insuring the Needs of Texas Businesses and Residents
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Commercial and Business Insurance from the Superior Insurance Agency
Commercial Liability

Commercial Property

Commercial Vehice/Fleet

Workers Compensation

Product Liability

Professional Liability


Personal Auto, Homeowners Insurance for Texas from the Superior Insurance Agency
Personal Auto Insurance

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On-Line Workers
Compensation Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal / Company Data:

Your Name:
Your Company's Name:
Street Address:
City:
State: (Must be Texas)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again (for accuracy):
Phone:
Fax (optional):
 


Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type NONE)
 
List Claims & Amounts Paid
(If none, type NONE)
 
Years In Business:
 
Business type:
(proprietorship, corporation, etc.)
 


 
Underwriting Information:
 
Describe IN DETAIL,
Your Business Operations:
 
Payroll Class #1:
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
Payroll Class #2: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
Payroll Class #3: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
 
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Superior Insurance, Inc. | 1347 19th Street | Plano, TX 75074
Phone: 972-423-2300 | Fax: 972-759-9781 | E-Mail: quotes@superiorinsuranceinc.com
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