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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
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Product Liability

Professional Liability


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On-Line Product Liability
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data

Your Name:
Business Name:
Property Address:
City:
State: (Must be Texas)
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):
 
Underwriting Information
 
Date Coverage Needed:
 
Prior Carrier:
 
Describe Business:
 
Gross Annual Receipts: $
 
Gross Annual Payroll: $
 
Square Footage of
Your Business Location:
$
 
Number of Employees:
 
Tell us what kind of
product coverage you
are looking for, and why:
 
How long do your products
remain in use or on market?
 
Who manufactures your
product and where?
 
Prior Claims? Yes No
Describe claims in detail:
 

Limits & Coverages:
Liability Limits: $100,000    $300,000
$500,000    $1 Million
Option for $2 Million or more
 
Business Contents Needed?
If so, list type and amount:
 
Comments/Remarks:
 
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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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