Request Information by Mail

For More Information. . .

Check one or more of the boxes below to receive information by mail.

Application for insurance for attorneys and law firms in private practice

A copy of the "Risk Management Self-Evaluation Questionnaire"

A copy of "Understanding Your Claims-Made Lawyers Professional Liablity Insurance Policy"

If you would like an immediate indication of approximate premium for your practice, please provide the information requested below.

A. Number of attorneys in your firm:

B. Limits of liability desired: $ each claim/aggregate

C. Deductible desired: $ each claim

D. Enter the "retroactive date" of your current professional liability policy (the date from which you have carried continuous, uninterrupted coverage up to the present) -- if you are not currently insured enter "0"

E. County in which your principal office is located:

F. Expiration date of your current policy (if none enter "0")

Please provide the contact information requested below.

Firm Name:
Contact Name:
Mailing Address:
City:	State: Zip Code:
Telephone:	Fax: Check if Part-Time:
E-Mail Address:	Number of attorneys in firm:
Renewal Date:

If you have comments or questions, or have experienced any problems in using this Web site, please describe below.

Thank you for visiting this Web site. Please check the information above and when correct click the "Submit" button. If you need immediate assistance please telephone Seabury at (800) 343-0132.

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