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The Lingard Agency
5100 S. 375 E. #B5
Ogden, UT 84405
 
Phone: 801-475-0622
Toll Free: 877-475-0623 Fax: 801-475-0623

Insuring Residents
and Businesses
In Utah

On-Line Commercial General
Liability Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data

Your Name:
Business Name:
Property Address:
City:
State: (Must be Utah)
Zip/Postal:
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Phone:
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Underwriting Information
 
Date Coverage Needed:
 
Prior Carrier:
 
Describe Business:
 
Gross Annual Receipts: $
 
Gross Annual Payroll: $
 
Square Footage of
Your Business Location:
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Number of Employees:
 
Tell us what kind of
commercial coverage you
are looking for, and why:
 
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Describe claims in detail:
 

Limits & Coverages:
Liability Limits: $100,000    $300,000
$500,000    $1 Million
 
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