Sims Insurance Services Logo
Independent Insurance Agent Independent Insurance Agent Call Today: 316-722-9977
Insurance Agency Home Page Locate our Building Contact us for a Free Quote
Personal Insurance Lines Business Insurance Lines Life Insurance Specialty Lines Insurance
ONLINE FORM CENTER
Sims Insurance Services
4621 N Maize Rd, PO Box 369
Maize, Kansas 67101
Get Map

Phone: 316-722-9977
Fax: 316-729-4744
Toll Free: 866-722-9977
Email Us
     ONLINE QUOTE FORM

Business Owners Package (BOP) & Commercial Insurance Quote

First & Last Name:  
Business Name:  
Street Address:  
City, State & Zip:  
E-Mail Address:  
Telephone:  
Fax:  

Current Insurance Information

Insurance Company Name:  
Any Losses in last 3 yrs?:  
Premium Amount:  
Policy Exp. Date:  
Describe the Type of Coverage
you Currently have:
  

About Your Business

# of Full-time
# of Part-time
Yrs. in Business
# of Locations:
Yr. building built
Sprinklered?
Annual Gross Sales
Square Footage?
Building Type:  
Type of Business:  
Owned Autos:  
Est. payroll / mo.:  

How did you hear about us?

Please describe your business here:  
Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.


Enter the text from the box:
click for new code