Free Quote | Cheapest Errors & Omissions Coverage E&O

Step 1 : Quote Page Questions

1. Choose Primary Industry:

2. Number of Years in Your Industry:

3. Primary State or Province of Operation:

4. Gross Annual Income (Owner Only):

5. Number of employees (excluding owner):

6. Gross Annual Payroll (Including Owner):

7. Gross Annual Business Revenue:

8. Currently Have an E and O Policy?

YesNo

9. Have you had a Claim in the last 5 years?

YesNo

10. Deductible:

11. Max Benefit Per Incident:

12. Aggregate Max Benefit:

* Please provide the information required above.

Click Here for Annual Rate Quote

Please contact our Customer Service Department if you wish to purchase more than one product. All additional products purchased, of equal or lesser value, will be at 1/2 price. Thank you.

By answering the above 12 questions, you can quickly and easily get a low rate on your next Errors and Omissions policy, and start to enjoy our coverage benefits to protect you and your business. Many Insurance carriers will require you to have an E and O policy Certificate of Coverage. We can usually email your certificate to you the same business day.

Thank you for filling out our quote form. To apply for coverage, please complete all answers on the application below.

The average time to complete the application is 10-15 minutes.

Having trouble? Please call our friendly and helpful Customer Service and they will help you to complete your application.

Step 2 : Full Application Questions

Personal info

First Name:

Last Name:

Email Address:

Birth Date:

Telephone:

– –

Cell phone:

– –

Address:

City:

State or Province:

Zip or Postal Code:

Business Info

Business Name:

Business Mailing Address:

City:

State or Province:

Zip or Postal Code:

Business Phone Number :

– –

Business Email Address:

Business Physical Address:

City:

State or Province:

Zip or Postal Code:

Best Time To Contact:

Morning Afternoon Evening Anytime

Business Website Address:

* Please provide the information required above.

1. Type of Business Entity:
2. Date Business Established:
3. Business License Number:
4. Number of employees:
5. Do you work out of a home office:	Yes No
6. Are you a subsidiary of another:	Yes No
7. What is your primary industry:
8. Number of Years experience in Your Industry:
9. List any additional industries you or your business works in, if any:
10. Give a brief description of your business activities:
11. Gross Annual Business Revenue:
12. Gross Annual Income (Owner Only):
13. Gross Annual Payroll (Including Owner):
14. Do you Currently Have an E and O Policy?	Yes No
15. Have you filed an E and O Claim Within the last 5 Years?	Yes No
16. Have you been refused E and O coverage for any reason in the last 5 years?	Yes No
17. List all industry certifications and licenses obtained:
18. List all professional memberships:
19. Do you give presentations of any kind?	Yes No
20. Do you use brochures in your presentations?	Yes No

21. Do you supply written literature to your customers	Yes No
22. Are you customers required to sign written contracts?	Yes No
23. Do you keep a log or account of all customer information?	Yes No
24. Do you keep a log or account of all customer contacts:	Yes No
25. Percentage of work performed by yourself
26. Percentage of work performed by your employees:
27. Do you have written agreements with all subcontractors you hire?	Yes No
28. Do you have each customer sign a written agreement of your rates and services?	Yes No
29. What type of marketing/advertising do you conduct?
30. Do you use a professional marketing/advertising firm?	Yes No
31. Have you personally or professionally filed for bankruptcy in the last 5 years?	Yes No
32. Has any lawsuit ever been filed, or claim otherwise made against the applicant or any partnership or joint venture of which the applicant has been a member, or any predecessors and business, or against any person, company or entity for whom the applicant has assumed liability?	Yes No
33. Is the applicant aware of any facts, circumstances, incidents, situations, misunderstandings, or conflicts that might reasonably be expected to give rise to a claim or lawsuit, whether valid or not, which directly or indirectly involves the company?	Yes No
34. The applicant represents that all the above statements and facts are true and that no material facts have been suppressed or misstated. Completion of this form does not bind coverage. Applicants acceptance of company's quotation and company's written agreement to be bound is required to bind coverage and to issue a policy. It is agreed that the information submitted on the estimated quote page and this application form shall be the basis of information for the issuance of a legal contract should a policy be issued, and will be attached to and made a legal part of the policy :	Confirm
35. All written, verbal, or otherwise received statements and materials furnished to the company in conjunction with this application are hereby incorporated by reference into this application and made a legal part hereof to the policy:	Confirm
36. E-Signature of Applicant (please type name for e-signature):
37. Company Title (CEO, VP, Owner, etc.):
38. How did you hear about us?
39. Requested Start Date:

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