Commercial Quote Request

Thank you for your inquiry. Please complete the form below to allow us to quickly repond to your request. If you prefer, you may contact us directly at contact@brockins.com or our commercial agents on "Meet our Agents" Page."

Full Name: 
Business Name: 
Type of Business: 
Day Phone: 
Street Address: 
City:  
State: 
Zip: 
Email Address: 
Type of Organization (LLC, Inc, etc.): 
Number of Owners, Partners, or Officers: 
Number of Emloyees, Excluding Owners, Partners or Officers: 
This Year`s Projected Payroll: 
This Year`s Projected: 
Amount of Building Coverage Needed: 
Amount of Contents Coverage Needed: 
Number of Owned Vehicles: 
Prior Insurance Carrier (If Any): 
Has Coverage Ever Been Cancelled or Non-renewed? 
If Yes, please explain reason for not renewing: 
Have You Had Losses or Claims in the past 5 Years? 
If Yes Please Describe and Provide the Date & Amount Paid for Each: 

Coverage Needed (please check all that apply):

Bonds
Builder`s Risk
Business Auto
Crime
Directors`/Officers` Liability
Equipment
General Liability
Professional Liability
Umbrella Liability
Workers Compensation
Other
Explain Other 

To prove you are a human, please tell us which has wheels?

Brock Insurance Agency
823 Chickamauga Avenue | Rossville, GA 30741
706-866-3394

218 Manufacturers Road | Chattanooga, TN 37405
423-362-5745

Privacy Statement

Securities offered through Kestra Investment Services, LLC (Kestra IS), member FINRA/SIPC. Brock & Spencer Benefits, LLC is a member firm of BenefitsPartners a platform of NFP Insurance Services, Inc. (NFPISI), which is an affiliate of Kestra IS. Brock & Spencer Benefits, LLC is not affiliated with Kestra IS or NFPISI.
Check the background of this firm on FINRA's Broker Check - http://brokercheck.finra.org/

This site is published for residents of the United States only. Registered Representatives of Kestra Investment Services, LLC and Investment Advisor Representatives of Kestra Advisory Services, LLC, may only conduct business with residents of the states and jurisdictions in which they are properly registered. Therefore, a response to a request for information may be delayed. Not all of the products and services referenced on this site are available in every state and through every representative or advisor listed. For additional information, please contact our Compliance department at 512-697-6000.