Business Insurance

We've helped thousands of people in Maryland, Virginia, West Virginia and Pennsylvania make smart, insurance buying choices. We can help you too.

Give us a call at 301.662.1144 to get a prompt quote, and hear what options are available to you. Or fill out this easy-to-use form and we'll provide you with a quick response.

Personal Information
Name
Address
City
 State
 Zip
Email Address
Home Phone
 Work Phone
Type of Entity
Current Business Insurance Information
Current Business Insurance Carrier
Renewal Date
Business Information
Name of Business
Business Address
City
 State
 Zip
Contact Person
Contact Phone
Describe Type of Business

Does your business occupy a building?     Yes No

If yes, is this building:    owned by you rented/leased
Number of Employees Full Time   Part Time  
Annual Sales
Annual Payroll

Have you submitted any claims in thepast five years? Yes No

   If so, please describe (include date(s) of loss and amount(s) paid)
Comments / Remarks

Powell Insurance Agency | 97 Thomas Johnson Drive, Suite 201 | Frederick, MD 21702

NOTICE OF LICENSURE
Powell Insurance Agency is licensed to conduct business in Maryland, Pennsylvania, Virginia, and West Virginia. The information on this site is a solicitation to conduct business only in the aforementioned state(s) of authority.