Online Quote

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Firm Name:

*Street Address:

Alternate Street Address:



*Zip Code:

*E-mail Address:

Phone Number: () - ext.

Fax Number: () -

Present Carrier:


Current Premium:

Prior Acts Date FULL or Other:

Limits of Insurance:


Firm Information

Establish Date:

Number of Attorneys:

Number of Counsel:

How many suits for fees has your firm filed in the past 2 years?:

Claim and Discipline History

Are you aware of any claims against your firm or any incidents that could result in a claim within the past 5 years?:

Yes   No  

If yes, how many?

Please provide specific details of each, including description of the allegations, any payments made, etc.

Have any lawyers in the firm had any disciplinary matters or grievances, or are any such proceedings in progress?

Yes   No  

Please provide a brief explanation.

Areas of Practice (percentages must total 100%)

Administration %
Arbitration/Mediation %
Banking/Financial Institutions %
Bankruptcy %
BI/PI Defense %
BI/PI Plaintiff %
Civil Rights/Discrimination %
Class Actions %
Collection/Repossession %
Corporate - Formation %
Corporate - General %
Criminal %
Divorce %
Elder Law %
Employee Benefits/ERISA %
Estate/Wills/Trusts %
Family/Juvenile-no divorce %
Immigration %
Intellectual Property %
Labor Employment %
Medical Malpractice %
Municipal %
Oil/Gas/Mineral Rights %
Real Estate Commercial %
Real Estate Foreclosures %
Real Estate Residential %
Securities %
Social Security %
Tax - Individual %
Tax - Business %
Tax - Opinions %
Workers Compensation - Defense %
Workers Compensation - Plaintiff %
Other %
Other (2) %