General Liability Insurance Quote

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Personal Information

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly. The form will not submit without completing all fields marked (Required).

Is your business registered in the USA?(Required)

If yes continue to the questions below – if no enter name and email address only – submit for further information.

Name(Required)

First Last

Company Name(Required)

DBA (please put none below if not applicable)(Required)

It is imperative that your business name or DBA match what your legal name is on the Seller Central Amazon account so they will accept the COI. Please click this link to verify the seller account name.

Address(Required)

Street Address Address Line 2 City State ZIP / Postal Code

Business Entity Type(Required)

Phone(Required)

Email(Required)

Business Information

Website(Required)

Link to Amazon Store(Required)

Business Start Date(Required)

MM slash DD slash YYYY

Current Insurance Carrier(Required)

Estimated Annual Gross Sales (for the next 12 months)(Required)

Types of Products Sold(Required)

Do you sell any Private Label merchandise?(Required)

Yes

If no, do you anticipate selling any Private Label merchandise in the next 12 months?

Yes

Do you repackage or relabel items?(Required)

Yes

Any past or potential future claims or Product Recalls?

Yes

Do you have an certifications from having your products tested to meet U.S. Safety Requirements?(Required)

Yes

Any changes or new products, goods or services in the next 12 months?(Required)

Yes

Do you sell dietary supplements?(Required)

Are the supplements your private label/brand?(Required)

Do you obtain Certificates of Insurance from your suppliers?(Required)

Are you listed as an additional insured on the COI?(Required)

Do you formulate your products?(Required)

Are formulas reviewed, tested, and verified by an independent third party?(Required)

Are all warning labels, instructions, and advertising material reviewed by outside counsel?(Required)

Do your products labels clearly state that the product has not been evaluated by the FDA?(Required)

Are any of your products designed, advertised, or labeled to promote weight gain, weight loss, muscle enhancement, or increased metabolism?(Required)

Are any of your products designed/advertised, or labeled for sexual enhancement or male enhancement use?(Required)

Are any products marketed for children or use in pre-natal or post natal care?(Required)

Percentage of total estimated gross sales to be generated from the following type of products:

Weight Loss(Required)

Body Building and Sports Nutrition(Required)

Sexual Enhancement(Required)

Do any of your products contain the following ingredient:

CBD(Required)

Kava(Required)

Magnolia(Required)

Yohimbe(Required)

Do your products meet applicable government or industry standards?(Required)

Do all of your labels clearly state all appropriate dosages, warnings, known side effects, and contraindications known by you?(Required)

Do any of your present, previous, or planned products contain any of the following ingredients? Check all that apply:(Required)

Androstenedione

Aristolochia

Cascara Sagranda

Colloidal Silver

DHEA

Gamma Hydroxy Butrate (GHB)

Germanium

Hydroquinone

Kava

Lobella

Pennyroyal Oil

Skullcap

Steroids

Willow Bark

Animal derived products

Bitter Orange

Chaparral

Comfrey

Ephedra

Germander

Hormone Replacement Therapy

Jim Bin Huan

Kratom

Magnolia

Sildenafil, tadalafil, vardenafil

Stephania

Synephrine

Yohimbe

Are any of your products UV protective (sunscreen, sunblock, etc)?(Required)

Do any of your products contain formaldehyde?(Required)

Do you need Coverage for you Inventory?(Required)

Inventory Coverage

Physical Address of Warehouse(Required)

Street Address City State ZIP / Postal Code

Warehouse Construction(Required)

Tilt-Up Concrete

Block

Frame

Steel

Other

Approximate Age of Warehouse Construction(Required)

Approximate Total Square Feet of Warehouse(Required)

Approximate Total Square Feet You Occupy at this Location(Required)

Security Devices(Required)

Central Alarm

Fenced

Fire Alarm

Sprinklers

Average Inventory Stored at this Warehouse(Required)

Maximum Inventory Stored at this Warehouse(Required)

Additional Locations(Required)

Do you import products from overseas?(Required)

Would you like a quote on Ocean Cargo?(Required)

Average Number of Shipments Annually(Required)

Average Value of a Shipment/Container(Required)

Maximum Value of a Shipment/Container(Required)

Would you like a quote on an Umbrella or Excess Liability coverage?(Required)

Do you have any employees?(Required)

Would you like a quote on workers compensation?(Required)

Number of employees(Required)

Annual payroll - broken down by employee(s) and job duty(Required)

State where employee(s) work(Required)

Detailed job duties of each employee(s)(Required)

Comment or Message

Which insurance products are you most interested in at this time:

General & Product Liability

Property/Inventory Coverage

Cyber Liability

Workers' Compensation

Shipping Container Coverage

Hired/Non-Owned Auto Coverage

Where dud you hear of us?

Google or Other Browser

Facebook

Merchant Referral

Other

Ocean Cargo

General & Product Liability

Inventory

Personal Information

Business Information

Inventory Coverage

How can we help you?

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