Finance Insurance

Professional Liability Indication Request

The form below is designed to gather enough information for us to provide you a quick premium indication. We will provide you with a professional liability policy quote from our most competitive carriers - within the state of Hawaii only..

Business Information:

Name of Firm:

Street Address:

City: State: Zip:

General Information:

Approximate Annual Revenues:

Residential Sales: (Including farms, ranches and raw land)

Non-residential Sales:

Non-owned property management/leasing:

Other Income:

Total Income:

_____________________

Sales Force:

Number of Full Time Agents:

Number of Part Time Agents:

Do 80% or more of your sales involve the use of Standard Contracts?
Yes No

What percent of homes are sold with a Home Warranty?

Do 80% or more of your sales involve the use of Disclosure Forms?
Yes No

Coverage:

How many years have you been purchasing Errors and Omissions Insurance?

Policy Period:
Effective: Expiration:

Limits of Liability:

Deductible Options:

Has your firm experienced any claims in the last five years? Yes No

Whom should we contact with the Indication?

Name (Owner or Broker):

Email Telephone Fax

Comments:

Note: If a claim has been experienced in the last five years a quote will be generated from a completed application.

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