Accountants Insurance Inquiry

This fast & easy-to-complete form will provide me with the basic information that I will need in order to contact you.  This form is not an application for insurance; I do not provide "quotes" for professional liability insurance over the Internet.

You may rest assured that any and all information will be held in the strictest confidence, and will never be shared with any third-party.  If, however, you are concerned about the issues of data transmission over the Internet, please feel free to call me directly at, 877-320-4061.

  • Please be kind enough to provide me with the following contact information:

    First Name Required
    Last Name Required
    Middle Initial
    Degree or Title
    Organization
    Street Address
    Address (cont.)
    City Required
    State/Province Required
    Zip/Postal Code
    Country
    Work Phone Required
    FAX
    E-mail Address Required
    Website

 

  • Please tell me what you do, and/or what type of professional you are:

    Certified Public Accountant
    Public Accountant

  • What insurance issues are you interested in discussing?

    Professional Liability
    Accounting Office Insurance Package
    Excess (umbrella) Liability
    Workers Compensation
    Other (please specify below)

  • Are you presently insured?

    YES
    NO

  • If "yes" when does your present coverage expire?

    -- mm/dd/yy

  • Please provide me with any comments or additional information that you feel might be helpful:

Copyright © 2000 Bruce R. Swicker, "The professional's insurance professional." All rights reserved.
Revised: July 01, 2002

Copyright 2002, Bruce R. Swicker, "The professional's insurance professional!"  All rights reserved.