Alabama insurance from Burkett Insurance
Meeting the Insurance Needs of Alabama Residents & Businesses for Over 15 Years!
 
Personal Auto, Homeowners Insurance from Burkett Insurance
Personal Auto Insurance

Homeowners Insurance

Boat Insurance

Motorcycle/ATV Insurance

Personal Umbrella


Commercial and Business Insurance from Burkett Insurance
General Liability Coverage

Contractor Liability Program

Professional Liability Coverage

Commercial Automobile

Commercial Property

Workers Compensation

Surety & Fidelity Bonds



Life and Health Insurance Products from Burkett Insurance
Life Insurance

Individual Health Insurance

Group Health Insurance

Disability Insurance



Other Insurance Services from Burkett Insurance
Service My Account

More About Our Agency

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Our Privacy Notice

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Online Workers
Compensation Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Personal / Company Data:

Your Name:
Your Company's Name:
Street Address:
City:
State: MUST be Alabama!
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again (for accuracy):
Phone:
Fax (optional):
 

Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type NONE)
 
List Claims & Amounts Paid
(If none, type NONE)
 
Years In Business:
 
Business type:
(proprietorship, corporation, etc.)
 

 
Underwriting Information:
 
Describe IN DETAIL,
Your Business Operations:
 
Payroll Class #1:
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here: 		$
 
Payroll Class #2: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here: 		$
 
Payroll Class #3: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here: 		$
 
 
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Burkett & Associates Insurance Ageny, Inc. . 2400 Bob Wallace Ave., Suite 206 . Huntsville, AL 35805
Phone: 1-256-704-7400 | Fax: 1-256-704-7402 | E-Mail us at: info@burkettinsurance.com
Our Telephone Quoting Hours are: 9:00am to 5:00pm (Monday-Friday) | View Our Privacy Notice
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