Benefits Consultation Intake

This intake is reviewed by Robert Rousseau, Executive Commercial Lines Account at Manager at Wheeler & Taylor Insurance.

It’s used to get a clear picture of your business and current benefits setup so we can put together a practical, tailored recommendation.

Business Basics

Tell us a bit about your business.

First Name *

Last Name *

Business Name

Email Address *

Phone Number *

Preferred Contact Time *MorningsAfternoonsEvenings

Company Profile

Number of Employees *1–1011-2526-5152-100100+

Description Of Business Operations *0 / 200

Date Established *

Website

Current Coverage

Do You Currently Have Insurance In Place? *YesNo

What Is The Name Of The Carrier? *

Have You Had Any Claims In The Last 5 Years? *YesNo

What Challenges Are You Facing Today?

Current Challenges *Rising CostsNot Happy With Current InsuranceNot Happy With Customer ServiceNon-Renewed With Current CarrierOther

What Are You Interested In?

What are you most interested in? *Commercial General LiabilityProfessional LiabilityProperty InsuranceCyber LiabilityWorkers Comp

Review & Submit

Just one final step to get your quote started.

Please take a moment to review your information before submitting. This helps us ensure your quote is accurate and tailored to your needs.

I confirm that the information provided is accurate and complete to the best of my knowledge.

I agree to be contacted to discuss this request and review coverage options.

I understand that this is a request for a quote and does not bind coverage.

Initial

Enter your initials as confirmation of the above statements. *0 / 10

Submit Your Request

Once submitted, I’ll personally review your information and reach out with next steps and coverage options that make sense for your business.

Best,
Robert Rousseau
Executive Commercial Lines Account Manager
Wheeler & Taylor Insurance

Please do not fill in this field.