Business Owners Insurance Quote 
In order to provide you with a quote and to determine your eligibility for our programs that we offer through various carriers, our agency and/or companies we represent may use information contained in credit, MVR reports, insurance loss history, and other various consumer reports.  In order to provide you with a quote, our carriers may also develop a credit-based insurance score using these reports and sometimes this is accomplished by using a third party.  For additional information on collection and disclosure of personal information, and your right to see and have the opportunity to correct any personal information in your files, please contact our office.   The reports provide us and/or our carriers with information that assists with determining your eligibility for insurance and the final price you are charged.  By completing these forms, you agree to this process in making a request for a quote.
Contact Information
Name of Business
Contact Name
 *
Address
 *
City
 *
State
 *
Zip
 *
Business Phone
 *
Fax Number
Contact Email Address
 
Current Insurance Information
Current Insurance Carrier
Premium $
Expiration Date
What type of coverages do you currently have?
Bond
Commercial
Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors and Officers Liability
Group Disability/Health/Life
Professional Liability
Workers' Compensation
Employment Practices Liability
Other (please explain below)
Please explain
 
Your Business Information
Number of Full-Time Employees
 *
Number of Part-Time Employees
 *
How Long in Business
 *
Number of Locations
 *
Estimated Annual Payroll
 *
Please give a brief description of your business
 *
Please select the type of coverages you are interested in:
Bond
Commercial
Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors and Officers Liability
Group Disability/Health/Life
Professional Liability
Employment Practices Liability
Workers' Compensation
Other (please explain below)
Please explain
Any additional comments or information that might be helpful
 
By completing this form you are acknowledging your understanding of and agreement with the following terms:
1. No coverage of any kind is bound or implied by submitting information via this online form.
2. Information from you and other sources such as your driving claims and insurance histories may be used to calculate an accurate price for your insurance.
3. We will not distribute information to other parties other than for insurance underwriting purposes.
4. We value your privacy. Every precaution has been taken to insure your privacy and security.
5. By submitting this form you agree to release us from any liability should this information be accidentally viewed by others.
Security code:
 *
Do not enter anything in this field:
* indicates a required field
 
Have questions or concerns about your insurance?
We can help.
Call 1-800-352-3416

For a quick quote, call us today!
We currently provide insurance services in: 
  • North Carolina
  • South Carolina
  • Virginia

    Please note: Changes to policies via this website are not effective or binding until you, or any party involved, receive official notification from your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

    First Casualty Insurance Group, Inc.
    190-A Turner Street
    Southern Pines, NC 28387
    1-800-352-3416
    fciginfo@fcignc.com
     
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