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

Office Map/Directions

Our Privacy Notice

Questions? E-Mail Us!

Online Contractor General Liability Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Name:
BUSINESS Name:
Mailing Address:
City:
State: MUST be Alabama!
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Business Underwriting Information
Type of operation:
Describe operations in detail:
License class:
License Number:
Social Sec. or Employer ID#:
 
Limit of Liability
Coverage Requested?		 $300,000
$500,000
$1 Million
 
Currently Insured? Yes No
Name of Carrier & how long insured?
Prior Claims? Yes No
Describe claims in detail:
 
Years in business:
Years experience in field:
Percentage of work residential:
Percentage of work commercial:
 
Number of Active Owners:
Number of Employees: 0   1   2   3+
Annual Employee Payroll: $
Annual Gross Sales: $
 
Do you subcontract work? Yes No
(If yes, what percentage of your work
is subbed, and what kind of work?)
Do you do foundation work? Yes No
Do you work on condos? Yes No
Employees paid over $18/hour? Yes No
Do you have a safety program? Yes No

 
Comments/Remarks:
 
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We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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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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