"Your Health Food Store & Vitamin Store insurance specialist!"
We are licensed in all of the states listed below and offer an exclusive
insurance program designed specifically for Health Food Store and
Vitamin Store businesses.
Full Name:          
Mailing Address:
City:     State:     Zip Code:
Email Address: (Required) 
Home Phone:   Work Phone:   Ext.
Current Insurance Company: 
Expiration Date: (mm/dd/yyyy)


DRIVERS LIST
                          Drivers                     Date of                Social                Drivers
Driver                 Name                        Birth               Security #           License #             Marital Status
     1                       Single   Married
     2                       Single   Married
     3                       Single   Married
     4                       Single   Married

VEHICLE LIST
Vehicle     Year        Make           Model        VIN (If available)
     1          
     2          
     3          
     4          

Coverage Limits
$20,000 / $40,000   $100,000 / $300,000   $250,000 / $500,000

Deductible
Comprehensive   $250 $500 $1,000
Collision              $250 $500 $1,000

Rental
Yes No
Towing
Yes No

Additional Information


Click on the "Submit Quote Information" button below
to send your Auto Insurance quote request.


Auto Insurance Quote
Applicant Information:
Information received from this auto insurance quote form sent to Kapatoes Insurance Services will be for our
use only and will not be sold, given to or distributed to any other parties. A quote will be based on the car or truck
insurance information provided and does not guarantee acceptance of the risk by us. The precise coverage
afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as
issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of
insurance. Completion of this form does not entitle you to auto insurance.
Copyright 2003-2010 Kapatoes Insurance Services - All rights reserved
Natural Foods Store
Request Auto Insurance Quote
The Country's Largest Insurance Broker for Retail Health Food Stores & Vitamin Stores
Kapatoes Insurance Services
Health Food Store & Vitamin Store Insurance Specialists
Commercial Insurance Agent Services
Alabama
Arizona
California
Colorado
Connecticut
Delaware
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
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Nebraska
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New Jersey
New Mexico
New York
North Carolina
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Wisconsin
You can also fax this information
toll free to: 1-888-453-5755
Kapatoes Insurance Services
800 Village Walk
Suite 251
Guilford, CT 06437
203-453-0392
Toll Free: 1-888-467-3330
Fax: 1-888-453-5755 (toll free)
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