Get an Insurance Attorney Application - Section 1

Get A Quote

To obtain a quote, please complete the form below or click here to download our application. Completed applications can be sent to info@lawyersinsurancealliance.com.

About the Firm

Firm Name*(Required)

The precise registered name of the applicant firm, as reflected on the firm's letterhead.

Street*(Required)

City*(Required)

State*(Required)

ZIP*(Required)

Contact Email*(Required)

Website Address

Is this location a work-at-home or virtual office arrangement?

Is the firm office or suites shared with other attorneys?

Firm Coverage Information

Coverage Effective Date*(Required)

Prior Acts Exclusion Date

How many years has the firm been continuously insured?

What year was the firm established?

Type of Entity?

Please specify:

Is this location where the firm meets with clients?

Does the firm have offices at other locations?

Does the firm practice in states other than the primary location?

Is the ratio of support staff to attorneys greater than 3:1?

Has the firm ever purchased an Extended Reporting Period?

Has the firm's coverage ever been non-renewed, cancelled, rescinded or declined by another carrier?

Does the firm desire coverage for any previously-dissolved predecessor firms and those affiliated attorneys?

Is there an attorney listed on the letterhead not covered by the firm's insurance?

Requested Coverage

Some limits/deductibles/optional coverages may not be available in all states and all are subject to underwriting qualification. Your quote will reflect the coverage and options for which your firm qualifies.

Select the Each Claim/Aggregate Limit the firm desires.

Select the Per Claim Deductible the firm desires.

Select any optional coverages the firm desires.

Aggregate Deductible

Claims Expense Outside Limits

First Dollar Defense

Title Insurance Agency

Note: The Title Insurance Agency optional coverage extends coverage to a specific title agency as a separate entity. A supplement application applies.

This field is for validation purposes and should be left unchanged.