(503) 668-2524 Sandy, OR

Business Quote-Test

Business Quote

* = Required Field
General Information
Contact Name *
Email *
Phone Number *

Business Name/Legal Name
Business Location Address
Zip/Postal Code*
Business Phone
Fax #
Business Information
Number of years in business
Number of Years in this profession  
Annual Gross Sales (or projected if new in business)  
Number of full-time employees  
Number of part-time employees  
Annual payroll  
Number of locations  
Brief description of your business & clientele

Seating capacity (if restaurant or pub)  
Cost of any subcontracted work  
Location/Premises InformationAddress

Current Coverages

Business Information
# of Full-Time Employees
# of Part-Time Employees
How long in Business? (yrs)
How many locations?
Please give a brief description of your business and clientele
Property/Premises Information
Occupancy Status  
Year Built
% Occupied
Construction Type
# Basements
Sq. Footage
Burglar Alarm  
Building Value
Other Property (specify)
Insurance Information
Annual Gross Sales: (before taxes)
Number of Employees
Annualized Payroll
Cost of any Subcontracted Work
Limits Requested

Describe any claims you've had in the past 5 years
Additional Comments
* = Required Field

Insurance products are offered by CCB Insurance Services LLC, not by Clackamas County Bank. CCB Insurance Services LLC is licensed as an insurance agent and acts as agent for insurers. Insurance policies are obligations of the insurers that issue the policies. Insurance products may not be available in all states. Insurance Products: • Are NOT Deposits • Are NOT FDIC-Insured • Are NOT Insured By Any Federal Government Agency • Have NO Bank Guarantee • May Go Down In Value. In the case of an application for credit in connection with which an insurance product is solicited, offered, or sold, the bank may not condition an extension of credit on either the consumer’s purchase of an insurance product from the Agency, or the consumer’s agreement not to obtain insurance from another entity.