Insurance Specialists , Inc . Has Been Providing Professional Liability Insurance Since 1965
Lawyers Professional Liability Insurance Premium Estimate
Applicant Firm Information
Firm Name Contact Person # of Attorneys in Firm Phone Number Fax Number
Street Address ( City , State , Zip Code , County )
E-mail Address
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 . 12 Lenox Pointe Atlanta , GA 30324
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 .
Phone : ( 888 ) ISI-1959 • Fax : ( 866 ) 871-2170 |
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E-mail : SalesDirect @ isi1959 . com |
Agent |
Date of Completion |