One Company, Endless Solutions

The Metropolitan Agency provides Personalized Insurance and Risk Management Solutions in the
New York Tri-State Area.


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Product Liability Insurance Quote Request

Please take a moment to fill out the form below and one of our local insurance agents will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

General Information
Name of Business:
Contact Name: *
Address:
City:
State:	Zip:
Business Phone: *
Best Time To Call:	AM PM
Contact E-mail: *

About Your Business
Number of employees	How long in business	How many locations	Estimated Annual Payroll
	years		$

Business Type:	Manufacturer Wholesaler Retailer Importer Exporter Other:

Please give a brief description of your business and operations:

Current Insurance Information
Insurance Carrier Name:
Policy Expiration Date:	Premium Amount: $
Years Insured:

Product Information
Nature of Product:
Estimated Annual Sales:
Number of Years Involved with Product:
Percent of Product Imported:

Claims History

Are you aware of any incidents, conditions, circumstances, defects, or suspected defects which may result in claims against you:
Yes No

Describe and Claims History:

Additional Comments or Questions

	Enter Security Code:

Please click the "Submit Quote Request" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.

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