Business Quote Request Please complete the information below. Our quote team is ready to go. Business Name:*State:*- SelectAlabamaArizonaGeorgiaIllinoisIndianaKentuckyMichiganOhioPennsylvaniaTennesseeTexasWest VirginiaBusiness Contact ONLY:* First Last Contact Person:* First Last Business Contact Phone Number ONLY:*Contact Phone Number:*Business Contact Email Address ONLY (a valid email address is required to complete this form):* Contact Email Address:* Preferred Method of Contact:*PhoneEmailBest Time to CallMorningAfternoonEveningESTCSTMSTPSTWho Are You Currently Insured With?*CNALiberty MutualTravelersOtherIf Other, Please Provide Carrier:*Has the business policy been non-renewed or cancelled in the last 5 years?*YesNoThe prospect has expressed interest in the following products: Property General Liability Auto Workers' Compensation Umbrella Other If Other, please specify:Referring Agent: First Last Referring Agent's Email Address:* What is your relationship to IHT?*IHT Producing AgentReferral AgentRenewal Month:- SelectJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemeberIndustry Category:*- SelectAutomotiveBusiness ServicesCommercial Building Leased to OthersContractorDistributorFood Products & RestaurantsGolfHealthcare (Excludes Professional Liability)HospitalityInstitutionalManufacturingProfessional ServicesRetailSchoolsServicesTechnologySpecific Automotive Industry:*- SelectAir-conditioning service, checking, charging, installation and repairAuto parts-(non-critical)Auto Quick LubeAuto Repair and ServiceBody repair and collision shopsBrake installation and repair, shocks and struts, exhaust systemsCar Wash - other than self serviceDetail shops, pinstriping, auto waxing and buffingElectrical repair and installation, including speedometer installationGeneral repair – with gas salesGeneral repair – without gas salesGlass installationOil change and lubricationPainting and pinstripingRustproofing, undercoating, glazingSound and communications equipment repair and installationTransmission repair and installationTune-up and emissions testingUpholstery, tops and sunroof repair and installationSpecific Business Services Industry:*- SelectAdvertising Sign CompanyAnswering Service - TelephoneDirect Mail ServicesDraftsmenGraphic Design and Commercial ArtMedia buyersOffice machine repair - shop onlyTelemarketing and Research ServicesSpecific Commercial Building Leased to Others Industry:*- SelectGarages and Gas StationsManufacturing, Processing, or Contracting OccupancyMercantile OccupancyMercantile Occupancy - No Food or DrinkOffice OccupancyReligious UseShopping CentersSpecific Contractor Industry:*- SelectAir Conditioning Equipment Install Service RepairAwning installationBuilding maintenanceCarpet and floor covering installationCommunication equipment - Cable and satellite installationConcrete - Mixed In transitCountertop installationDoor, Window or Assembled Millwork - Installation - MetalDriveway, Parking Are or Sidewalk - Paving or RepavingDry Wall or Wallboard InstallationElectrical Apparatus Installation Service RepairElectrical Work within BuildingsExcavationHeating and A/C Installation, Service, and RepairInteriorIron works – decorative or artistic ONLYIrrigation or drainage systems constructionJanitorial or Cleaning Services - Residential or CommercialLandscape GardeningLawn and garden sprinkler installationLawn CareMasonry Contractor (Brick or Stone Work)Monument engraving and installationPaintingPlastering or StuccoSeptic Tank Installation, Service, RepairSiding Installation - Including Gutters and DownspoutsSign Erection, Installation, or RepairSign painting and letteringTile, Stone, Marble, Mosaic Work - Interior OnlyWater softening equipment installationSpecific Distributor Industry:*- SelectAluminum Ware - DistributorArtists Supplies DistributorAutomobile Glass DistributorBuilding Materials Dealers and DistributorsCeramic Distributors - Excluding KilnsCommercial Cooking Equipment DistributorElectrical Equipment DistributorsEngineers' and Architects' Equipment DistributorFabric DistrubutorsFence DealerFrozen Food DistributorGame Machines (Coins Operated) DistributorGlass Dealers and GlaziersGrocery DistributorHardware & Tool DistributorHearing Aid DistributorHeating and A/C Equipment Dealer or DistributorIce Dealer and DistributorJanitorial Supplies Dealers or DistributorsLandry Equipment and Supplies DistributorMachinery or Equipment Dealers- Including Yard and Garden TypeMetal Distributor - Non-Structural, Not Scrap MetalMisc. Distributors - Food or drinkMonuments and Grave Markers DistributorNewspaper or Magazine DistrubutorOphthalmic Goods DistributorPaper Products DistributorPlumbing Supplies and Fixtures Dealers and DistributorRefrigerators (Household) DistributorShelving DistributorTrophy DistributorsUndertakers' and Morticians' Equipment/Supplies DistributorVending Machine Distributor - No TobaccoVoting Machine DistributorSpecific Food Products & Restaurants Industry:*- SelectAsianBagel shopsBakeriesBeverage BottlerBeverage stores – no alcoholic beveragesBread, Cake, related productsBuffetButcher shopsCafeteriaCandy or Confectionary Products MFGCasual diningCaterersCheese shopsCoffee ShopsCoffee, Tea, and Spice StoreConessionaireCookie storesDairy Products MFGDelicatessensDonut shopsDrive-in – service in carFine DiningFood courtsFood Products MFGFruits and vegetables StoreIce cream and frozen yogurt shops – no cookingItalian Food RestaurantJuice BarsLiquor StoreMeat, Fish and Poultry StoreMexican take-outMilk Depot or DealerMilk ProcessingOther ethnic cuisinePet Food MFGPizza – no deliveryRestaurants - Less than 35% of Sales from Alcohol and No Dance FloorSeafood RestaurantSpecialty foodsSteak or Barbecue RestaurantSubs and sandwich take-outWater BottlingSpecific Golf Industry:*- SelectGolf - Driving RangeGolf CourseGolf Course-MiniatureGolf equipment storesSpecific Healthcare (Excludes Professional Liability) Industry:*- SelectAcupuncturistsAmbulatory Surgery CentersAudiologists – testing onlyCardiac Cath Lab - Ambulatory Surgical CenterChiropractorsCommunity Health CentersConvenience Care Clinic (Retail Setting) - Health Practitioners OfficesDental LaboratoriesDentist or Oral Surgeon OfficeDialysis CentersEmployee Health ClinicsEndoscopy CentersHearing aid and audiology centersHyperbaric Oxygen Therapy - FDA Recognized ConditionsImaging Labs - Including X-Ray, Radiology, Cobalt, EKG, etc.Laboratories - MedicalLaboratories - ReferenceLaboratories - Routine Clinical PathologyLithotripsy CentersMedical Billing ServicesMedical OfficesMedical Offices - Operated by groups of physicians as an outpatient clinicMedical Weight Loss ClinicsNurse PractitionersOptometristsOsteopathsPain Management CentersPhysical Therapists and Occupational TherapistsPodiatristsPsychiatristsPsychologistsRehabilitation CentersSleep CentersSmoking ClinicsSpeech TherapistsStudent Health CentersSubstance Abuse Centers (Outpatient Care)Vascular Access Center - Ambulatory Surgical CenterSpecific Hospitality Industry:*- SelectHotelsMotelsSpecific Institutional Industry:*- SelectAlumni Associations - Not for ProfitAssociations - Not-For-Profit, Including Business, Civic, Professional, and Trade Assoc.Chamber of CommerceCharitable FoundationsChurch or House of WorshipClub - Civic, Service, Social, Country, Golf, Racket Sports, HandballCommercial Condominium Association - Mercantile Occupancy (Association Risk Only)Commercial Condominium Association - Office Occupancy (Association Risk Only)Convents or MonastariesLibrariesMuseums / Art GalleriesOwner-occupied religious institutionsRectoriesSpecific Manufacturing Industry:*- SelectAir Conditioning Equipment MFGAppliance and Accessories MFGBilliard Table MFGBottle and Jar MFGBox or Container MFGBrick MFGBrush or Broom MFGButtons or Fasteners MFGCandle MFGCanopies and Awnings MFGCaulking Compound, Putty or Similar Products MFGClock MFGCoffin or Casket MFGCommunication or Recording Systems Equipment MFGComposition Goods MFG - Not Floor CoveringsComputer MFGConcrete or Plaster Products MFG - Not StructuralDie Casting MFGDoor or Window MFGElectrical Euipment MFG (Including Parts, Components, and Accessories)Electrical Wire or Cable MFGElectronic Games MFGElectronic Products MFG - Tube, Sockets, RetainersFurniture MFG or AssemblyGlass or Glassware MFGInstrument MFG - Analytiacal, Calibrating, Measuring, Testing, Recording, ControlJewelry MFGKitchen Utensils MFG - Including Cuttlery, Silverware, and FlatwareLaboratory Analytical Instruments MFGLight Bulb/Tube MFGLithographing and Patterns on MetalLubricants MFGLuggage MFGMachine ShopsManufacturers RepMarble Products MFGMatch MFGMattress or Box Spring MFGMetal Goods MFG - Including StampingMetal Heat ProcessingMetal Products MFG - Bolts, Nuts, Screws, Rivets, WashersMonuments, Tombstones & Statuary Products MFGMusical Instument MFGNails, Needles, Pins, Tacks MFGOffice Machine MFGOptical Goods MFGOther Manufacturing or ProcessingPaper Goods MFGPipe or Tube MFGPlastic or Rubber Goods MFGPlumbing Fixtures MFGPrefabricated Building MFGPumps or Compressors MFGRefrigeration Equipment MFGSafes and Vaults MFGSewing Machine MFG - Household or Commercial UseSheet Metal Shops (Not Stamped)Shoe, Boot, or Slipper MFGSign MFG - Electrical or MetalTelecommunications Equipment MFGTextile Products Manufacturing - Printing on FabricTool MFG - Cutting Tool AccessoriesTools MFG - Metal Hand Tools (Not Powered)Umbrella or Cane MFGVending Machine MFGWatch & Watch Casing MFGWicker, Willow or Twisted Fiber Products MFGSpecific Professional Services Industry:*- SelectAccountants and BookkeepersActuarial ServicesAdvertising AgenciesAgriculteral ConsultantsAnalytical ChemistsArchitectural Consulting ServicesAsset ManagersClaims adjusters – independentCommodity BrokersConstultants - NOCConsultants - Business Management OnlyEngineering ConsultantEngineers or ArchitectsFinancial PlannersInspection and Appraisal CompanyInsurance AgentsLaboratories - Research (Excluding Medical, Dental, X-Ray)LawyersMortgage brokersNOTARIES - PUBLICPublic RelationsReal Estate AgentsSales or Service - Consulting OrganizationStock BrokersSurveyorsTitle AgentsVeterinariansSpecific Retail Industry:*- SelectAir-conditioning, heating suppliesAntique storesAppliance StoreAquarium supplies and tropical fishArmy & Navy StoresArt, pictures and postersAudio/visual equipmentAutomobile accessoriesBarber or Beauty Supplies – RetailBicycle StoresBlanket and beddingBook StoresBridal StoresCake decorating equipment and suppliesCamera and Photographic Equipment StoresCandle shopsCard, Stationery and Office Supplies StoresCarpet, floor coveringsCeramics and potteryChristmas storesClock and Watch StoresClothing, Apparel, and Accessories StoresCollectibles and Memoribilia Store (Stamps, Coins, Cards, etc.)Computer and Software StoresConvenience store – no gas pumpsConvenience store – selling gasCosmetic or Hair/Skin Preparation StoresCostume / Formal Wear Rental StoresCraft, Hobby and Artist Supplies StoresCurtains, draperiesDepartment stores – no cookingDrugstore retailEducational & School Supplies - RetailElectrical suppliesFabricsFlag and banner storesFloristsFrame shopsFurniture StoreGift, novelty, souvenir shopsGrocery StoreHardware StoresHealth or Natural Foods StoreHearing Aid StoresKiosks – non-foodKitchen accessories, including cutleryLamps and Lighting fixturesLawn, Garden or Outdoor fixturesLeather Goods or LuggageLingerie, hosieryMarble Products SalesMedical, Hospital and Surgical Supply StoresMisc. Retail StoresMonuments, Tombstones & Statuary StoreMusical Instruments or Music StoreNewspaper and Magazine StandsNursery-GardenOffice Equipment and Machine Sales, Service, RepairOffice FurnitureOffice SuppliesOptical GoodsPaint, Wallpaper, or Tile StorePaper and paper productsParty Goods StoresPet StorePlumbing and heating suppliesPottery StoresPrecision or Scientific Tools & Instruments StoreRecords, tapes, compact discsRefrigeration equipment suppliesReligious Supplies StoreRestaurant Equipment, Fixtures, and SuppliesSaddlery StoresSewing Machine SalesShoe StoreSign StoresSpecialty Clothing and Accessories StoresSporting Goods StoresSunglasses shopsSupermarketToy StoreTrophy StoresUniform Stores - RetailVaccum Cleaner Sales and ServiceVariety storesVending Machine OperationsVenetian Blind/Window Shades StoresVideo storeWarehousesWig shopsYarn shopSpecific Schools Industry:*- SelectAccounting SchoolBeauty SchoolBusiness & Secretarial SchoolCorrespondance SchoolData Processing & Computer Training SchoolInformation technology schoolsMedical & Dental Assistants & Technicians SchoolTrade or Vocational SchoolSpecific Services Industry:*- SelectAppliance and Accessories Instal Serivce Repair- Commercial or Household UseAppraisers - Including Autos, Fine Art, or Personal PropertyArt StudiosAuctioneers - Sales Conducted Away from Insured's PremisesAudio ConsultantsAuthors and PlaywrightsBarber/beauty shopsCable or Subscription TV CompanyCarpet, Rug and Upholstery Cleaning-Shop ONLYCarpet, Rug or Upholstery Cleaning- on Customer's PremisesCredit and Debt Counseling ServicesDiaper, uniform and linen supplyDisc jockeys and musiciansDog/Pet Training (No Attack, Guard or Law Enforcement)Dry cleaners and laundries- Cleaning on PremisesDry cleaners and Laundries-Receiving Stations-Excludes Cleaning on PremisesEngravingFilm processingGemstone Polishing or CuttingInterior DecoratorsKennels - Breeding, Boarding/SalesKennels - Excluding Breeding & SalesKey cuttingLawnmower and Small Engine RepairLocksmithMusical instrument tuning or repairNail SalonsPet Day Care or Pet SitterPet GroomersPhotocopy, Duplicating ServicesPhotographers or Photographic StudiosPrinters / PublishersRadio or Publishers RepresentitiveRadio or Theatrical Program Production/DistributionReal Estate Property ManagedRecording StudioSewing Machine RepairShoe Repair ShopsSmall appliance repair - shop onlyStone Cutting & Polishing - Excluding GemsTailor shops - men's and women'sTaxidermistsTelevision, stereo and VCR repair - shop onlyTheatersTicket Sales and Ticket AgenciesTravel Agency - No ToursTravel agency - With ToursUpholsteringVideographersWedding ConsultantsSpecific Technology Industry:*- SelectCommunication Services - Management ProvidersCommunication Services - Satellite/Microwave (Radio) Transmission ServicesComputer maintenance and servicesComputer ProgrammingComputer Rental or LeasingData Communications VendorsData processing or Business Process OutsourcingInformation Search, Retrieval and Indexing ServicesInformation Technology ConsultantsInformation Technology Facilities ManagementInternet Access ProvidersLocal & Long Distance Service ProvidersMedia DuplicationPre-Packaged Software – Development and DesignSoftware development or programming servicesSystem Integrators and Integrated Systems DesignVideotape Editing - For Personal/Small BusinessWebsite Design and Development ServicesComments & Remarks:"I have received consent from the consumer via quote request to contact them and provide a quote AND I verify that I am contracted with IHT to submit warm leads."* I Agree "I give my consent to receive contact via IHT Business Quote Request."* I Agree Submit This iframe contains the logic required to handle Ajax powered Gravity Forms.