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Professional Liability Quote
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Name:
Address:
City:
Province:
Postal code:
What is the nature of your business:
Do you currently have professional liability insurance:
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Yes
No
Click here if you answered "Yes" to the above question
What is the name of the insurance company:
Year business started:
Owners' years of experience in the business:
Number of owners and / or partners:
Number of full time employees:
Number of part time employees:
Number of sub-contractors:
How many transactions do you process each month:
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1 to 100
101 to 500
501 to 1000
1001 to 2500
2501 to 5000
Over 5000
Do you have a bank account:
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Yes
No
What is the legal entity of your business:
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Sole proprietor
Partnership
Limited liability partnership
Cooperation
S Corporation
Limited liability company
Non for profit organization
Other
Click here if you picked "Other"
Please describe:
What liability limit would you like quoted:
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$1,000,000
$2,000,000
Other
Click here if you picked "Other"
Please describe:
How may we contact you:
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Email
Phone
Email or phone number:
Additional Information
Comments or additional information:
