INSURANCE MADE EASY©

COVER YOUR WORLD

Allen/Freeman/McDonnell Agency

will be happy to quote your

Professional Liability Insurance.

Be advised that we are only licensed to provide insurance in Maine and New Hampshire. Please answer each question that follows and then send the form to us over the internet. We will try to contact you within 24-hours. Thanks for considering

Allen/Freeman/McDonnell Agency.

Printable forms
Lawyers Professional Liability Quote
CPA Professional Liability Quote

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Items with an asterick (*) beside them indicate a question that must be answered to receive a quote.

Malpractice Insurance Quote Request
Business or Firm Name:*
Address:*		City:*
State:*		Zip Code:*

Firm Contact Name:*
Phone:*	FAX:	E-Mail:*

What type of malpractice insurance do you need?

Present insurance company?*	Policy Renewal Date?* (mm/dd/yy)	How long with current carrier?* Years
Does your current policy contain? Prior Act Exclusion or RetroActive Date	Date: (mm/dd/yy) Date: (mm/dd/yy)

Addtional Information About Your Needs

Please give us information about the type of insurance, the limits you need and as much other information as you can. Please call us at 1-800-762-8600, if you need the fastest service we can provide.

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NOTICE: Please be advised that insurance coverage cannot be changed or bound by submitting or leaving an electronic message or voice mail message. Allen/Freeman/McDonnell Agency nor its parent company, Insurance Made Easy, Inc. does not resell or distribute your personal information in any form. We use the information from this form exclusively to try to provide you the insurance coverages which you are requesting. In completing this form, you give us premission to telephone you, if needed.