Name of business:

Are you the owner? Yes No

How long in business? 0-5 5-10 10-15 more than 15

Coverages desired
auto
building
liability
workers compensation

Any losses in the past three years? Yes No

Auto | Home Owner's | Life | Health | Business | FAQ's | Dictionary | Quiz | About Us | Links |

© 1997 East Lake Insurance Agency

2404 East Lake Road Erie, PA 16511 (814) 459-4380 Fax (814) 459-4583