Intermountain Insurance Services, Inc.
Office: 530-336-5565
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Commercial Property & Liability
To find out how we can improve your insurance programs, please give us the following information. Be sure to answer the questions as thoroughly and accurately as you can. Please note: Your privacy is in our respectful care. We will share only the information needed with our preferred insurance carriers for quote processing only on a confidential, one-on-one basis.



Please fill out the following information so we may provide you with a free consultation.

Company Name (dba)
First Name
Last Name
Middle Initial
Address
City
State
Zip
Telephone
Fax
E-Mail
Please Confirm E-Mail:
How do you prefer to be contacted?
Description of Business
Description of Locations
What time of entity is your company?
Date of Incorporation?
Total number of full-time employees?
Total number of part-time employees?
Total annual revenue?
Total annual payroll?
Current type of insurance policy?
Current Insurance Carrier
How Long
Other than cost, what would you like to fix in regards to your current policy?
If we could fix those things, where would we need to be in order for us to do business?

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