MACPA - Maryland Association of CPAs PLI Insurance Quote Form

The only Professional Liability Insurance program endorsed by the MACPA

In order to receive premium indications on this increasingly needed coverage, please complete the following questions:

Contact Information
Firm Name:
Contact Name:
Address:
City:
State:	Zip:
Business Phone:
Fax:
E-mail Address:
Person at Firm responsible for Professional Liability Insurance:

Questionnaire
1.	Are You Currently Insured? Yes No
2.	Your Current Carrier:
3.	How many years have you had continuous coverage?
4.	Number of accounting professionals in your firm:
5.	Total gross billings for past fiscal year:
6.	Have you had any claims in the past five years? Yes No
	If Yes, how many claims have you had?
	Amount paid to settle claim:
7.	Current limit of liability:
8.	Current deductible:
9.	Current premium:

Please click the "Submit Quote" button to send your quote request.

This is a request for quotation only. No coverage is in effect until bound by an insurance carrier.

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