from Insurance Specialists, Inc.
Providing Professional Liability Insurance Since 1965
This is a paid advertisement and the Atlanta Bar Association does not endorse or in any way guarantee any of the products or services of this company.
Lawyers Professional Liability Insurance Premium Estimate
Applicant Firm Information
Firm Name
Contact Person
# of Attorneys in Firm
Phone Number
Fax Number
E-mail Address
Street Address (City, State, Zip Code, County)
Practice Survey Indicate the percentage of firm income derived from each area of practice.
1. Area of Practice
% of Firm Income
4. Area of Practice
% of Firm Income
2. Area of Practice
% of Firm Income
5. Area of Practice
% of Firm Income
3. Area of Practice
% of Firm Income
6. Area of Practice
% of Firm Income
To receive RAPID RATE premium estimate,
please complete and return this request to:
Insurance Specialists, Inc. - Professional Liability Dept.
305 Carteret Street
Beaufort, SC 29902
Phone: (888) ISI-1959 • Fax: (866) 871-2170
E-mail: [email protected]
Please attach a copy of firm letterhead and a copy of policy declarations
page (if available). Coverage may be bound only upon submission and
acceptance of a fully completed application.
Agent
Date of Completion