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Rockdale Life Agency, Inc
Sales@RockdaleLifeAgency.com
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Premier Business Insurance Coverage
Smart Protection For Your Business
Zip Code
Zip Code:
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Great! What is the business name?
How many partners/owners?
How many full-time employees?
How many part-time employees?
How many sub-contractors?
What is the entity/status?
How many years in business?
What is the gross annual revenue?
Briefly describe your business
How much property/casualty insurance?
(check any that apply)
What are the desired employee benefits?
(check any that apply)
What is the gross annual payroll?
What is your full name?
What is your email address?
What is your phone number?
Great! What is the business name?
*
Continue
How many partners/owners?
*
1
2-3
4-6
7-10
11-20
21-30
31-40
41-50
50+
How many full-time employees?
*
0
1
2-3
4-6
7-10
11-20
21-30
31-40
41-50
50+
How many part-time employees?
*
0
1
2-3
4-6
7-10
11-20
21-30
31-40
41-50
50+
How many sub-contractors?
*
0
1
2-3
4-6
7-10
11-20
21-30
31-40
41-50
50+
What is the entity/status?
*
Partnership
S Corporation
C Corporation
Joint Venture
Limited Liability Corporation
Individual/Sole-Proprietorship
Municipality
Trust
How many years in business?
*
0-2 Years
3-5 Years
6-10 Years
11-20 Years
20+ Years
What is the gross annual revenue?
*
Less than $50,000
$50,001-$100,000
$100,001-$250,000
$250,001-$500,000
$500,001-$1,000,000
$1,000,001-$5,000,000
$5,000,001-$10,000,000
$10,000,000+
Briefly describe your business
*
Continue
How much property/casualty insurance?
*
(check any that apply)
None
General Liability
Commercial Auto
Commercial Property
Professional Liability (E and O)
Directors and Officers Liability
Business Owners Package Policy (BOP)
Workers Compensation
Commercial Crime
Continue
What are the desired employee benefits?
*
(check any that apply)
None
Group Health Insurance
Group Life Insurance
Group Disability Insurance
401K / Retirement Plans
Supplemental Plans / AFLAC
Key Man Life Insurance
Key Man Disability Insurance
Deferred Compensation
Continue
What is the gross annual payroll?
*
Less than $50,000
$50,001-$100,000
$100,001-$250,000
$250,001-$500,000
$500,001-$1,000,000
$1,000,001-$5,000,000
$5,000,001-$10,000,000
$10,000,000+
What is your full name?
*
Continue
What is your email address?
*
Continue
What is your phone number?
*
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