PROFESSIONAL LIABILITY INSURANCE INDICATION REQUEST
 
For Accountants, CPAs, Bookkeepers & Tax Preparers
 
 
 
 
 
 
Request a consultation with a professional Liability Expert to help you evaluate your insurance needs.
 
 
 
 
First Name*
 
 
Last Name*
 
 
 
Email*
 
 
Phone*
 
 
 
State*
 
 
 
 
What Association are you a part of?*
 
 
 
I am a(n):*
 
 
 
Number of Financial Accounting Professionals*
 
 
Years in Practice*
 
 
 
Gross Income*
 
 
 
 
 
 
Current Professional Liability Provider Info (if you currently don't have professional liability, leave blank)
 
 
 
 
Upload declarations page if you already have coverage. If you do not have a declarations page or current coverage, please click Submit and an application will be emailed to you.
 
 
 
 
 
 
Provider Name
 
 
 
 
Current Premium
 
 
 
Renewal Date
 
 
 
 
 
 
 
Association Referral
 
 
 
 
Agency