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Call us! 620-792-4515
Toll Free: 866-792-4515

Welcome
 

Builders Risk Request

Request Information
Insured Name:
Insured Address & Contact Information
Address: (City, State & Zip)  
Phone Number  
Email Address  
Start Date
Job Address
Addition?  Remodel?  Commercial?  Residential?  Other?
Description of Job
Cost of Completed Job
Construction Type
Number of Stories   Square Footage
Intended Occupancy
Masonry Veneer Included? Yes  No
Deductible Options $1,000 Other:
Lienholder Yes  No
If Yes, Name and Address of Lienholder:
Owners Name & Address (if different from builders)
Date:

 
 

1911 Lakin Avenue
Great Bend, KS 67530

Phone: 620-792-4515
Fax: 620-793-3311

Email Goss Insurance

 

 

Phone: 620-792-4515
Toll Free: 866-792-4915
Fax: 620-793-3311

1911 Lakin Avenue
P.O. Box 1910
Great Bend, KS 67530-1910

www.gossins.com
Email Goss Insurance

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