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Product Liability Quote Request Form

Please complete and submit this short form and Paul Owens will quickly review and will be in touch with you shortly. Note: We do not work with insurance agents and brokers. We only work directly with product businesses.

Business Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Contact Name*
First Last
Title
Email*
Phone*
Website
Type of products you sell:*
Are you a start up?*
- Yes
- No
Is your product already on the market?*
- Yes
- No
If no, have you developed instructions and warnings?*
- Yes
- No
What are your projected 12 month gross sales estimates?*
Do you currently have insurance?*
- Yes
- No
If yes, what is your renewal date?*
MM slash DD slash YYYY
Select which desciptions apply to your operations (you can choose more than one)*
- Manufacturer
- Wholesaler
- Retailer
- Inventor
- Installer
- Importer
- Exporter
Why do you want to carry insurance (you can choose more than one)*
- Satisfy contract requirements
- Protect myself
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Sadler & Company, Inc.

3014 Devine St.
P.O. Box 5866
Columbia, SC 29250

1-800-622-7370 Toll‌ Free
1-803-254-6311 Local
1-803-256-4017 Fax
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Doing business in California as SPG Insurance Solutions License No. 0L09546. All Rights Reserved.

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