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PAMB Errors and Omissions Quote Form
 









 

 

 

 

Life, Health, and
Disability Quote

 

 

 

  


 

Contact Information
Applicant's Name:
Contact Name:
Address:
City:
State:   Zip:
Business Phone:  
Fax:
E-mail Address:

Questionnaire
1. Date business was established:
2. Are you owned by, or affiliated with other companies, or do you have any subsidiaries? Yes No
  If Yes, provide an explanation:
3. Have any claims been made or legal proceedings begun against the applicant or any members of the firm? Yes No
  If Yes, provide an explanation:
4. Please indicate the approximate percentages of your operations involving:
  a. Loan Underwriting: %
  b. Loan Servicing: %
  c. # Of loans serviced: Volume:
  d. Loan Brokerage Only: %
5. Do you have a warehouse line of credit? Yes No
  If Yes, what amount: $
and with whom:
6. Please provide the following information regarding your company's originated loans:
  a. Number of loans originated in the last 12 months:
  b. Average loan value: $
  c. Maximum loan value: $
  d. Percentage of residential origination: %
  e. Percentage of commercial origination: %
7. Does your company have Errors & Omissions coverage currently in force?
Yes No
  If Yes, provide the following:
  Company Name:
  Limits of Liability: Deductible
  Expiration Date:
  Prior Acts Date (if any):
  Current Premium: $
8. Are you a current PAMB member? Yes No
9. Please provide your company's estimated gross income for the coming year:
$
10. Number of employees:


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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