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Church Quote


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

First Name
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Last Name
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How did you hear about us?
Optional
E-Mail Address
Required
ZIP / Postal Code
Required
Phone Number:
Required
Church Name:
Required
Church Address:
Required
Mailing Address:
Optional
Miles from Fire Dept:
Optional
Ft. from Fire Hydrant:
Optional
Coverage Amount desired for Building 1:
Required
Coverage Amt. desired for Building 2:
Optional
Coverage Amt. desired for Contents:
Required
General Liability coverage amt. desired:
Required
Age of Building #1:
Optional
General Condition:
Optional
Is the Church kept locked?
Optional

Wiring last updated:
Optional
Roofing last updated:
Optional
Plumbing last updated:
Optional
Heating last updated:
Optional
Building Length
Optional
Building Width:
Optional
Building Height:
Optional
Basement:
Required
Total Square Footage, main floor:
Optional
Total Square Footage, basement:
Optional
Total Square Footage, balcony:
Optional
Age of Building #2
Optional
General Condition building #2:
Optional
Building #2 Wiring last updated:
Optional
Building #2 Roofing last updated:
Optional
Building #2 Plumbing last updated:
Optional
Building #2 Heating last updated:
Optional
Building #2 Length:
Optional
Building #2 Width:
Optional
Building #2 Square Footage:
Optional
Stories
Optional
Building #2 Basement:
Optional
Is the Church rented for any Community Functions, Special Events or used as a School or Day Care Nursery?
Optional

Does the Church have its own Cemetary?
Optional

If Yes, please give location and no. of acres:
Optional
Is Church used on a regular basis?
Optional

Current Ins. Carrier:
Optional
Current Annual Premium:
Optional
Please list all losses in the last 3 years:
Optional
Are you interested in Director & Officer coverage?
Optional

Are you interested in Sexual Misconduct coverage?
Optional

Are you interested in Pastors Conseling coverage?
Optional

Are you interested in auto insurance for any church vehicles?
Optional

Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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