Complete Church Quote
Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.
To ensure you will be contacted directly and in a timely manner, please double check your contact information. After this section, you will have the ability to skip by using the "next page" button at the bottom right of the forms.
We look forward to getting your quote started. Please tell us some general information regarding your church.
Please list the policy effective date
What is the primary operation?
Date of Claim, Type of Claim, Amount Paid, Claim Status (open, closed, pending)
Example: 08/11/2013, hail damage on roof, $1,613, closed
Loss History: list loss information following the format given in example above OR, upload your own loss history document in the box below.
Select desired limits on the following coverages.
Products and Completed Operations
Personal and Advertising Injury
Check box if additional types of exposure applies to your church
Select desired limits on the following coverages:
For each class code, please list duties, payroll, and #of full/part-time employees:
Policies & Practices: Check all that apply
Is there an audit done by any of the following?
Does audit include inventory?
Audit report is rendered to who?
Are bank accounts reconciled by someone not authorized to deposit or withdraw?
Is countersignature required?
Does your church currently carry Director, Officers and Trustees Liability coverage?
Has there been any change in Board of Directors in the past year?
Are Board of Directors elected by membership?
Have policies/procedures been reviewed by an attorney?
Are there any incidents or circumstances known to you or any other employee that have not yet been reported to the prior carrier, and for which there is reason to believe that such incident or circumstance may give rise to a future claim?
If "yes" to the question above, please explain:
Notice: Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverage's. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.