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Please complete the following form and press "submit". Your information will automatically be forwarded to our agency. The information you provide will be kept confidential between you and our office. Due to the complexity of church insurance, our office will contact you for additional information.

Contact Name:
Church Name:
Address:
City: 
State:    Zip:
Telephone:
Fax:
E-Mail:

Church Information

Type of Business Ownership:
Years in Business:
Number of Locations: 
Number of members (if applicable):
Schools / Daycare (if applicable):


Indicate Types of Coverages Applicable

Property
 Glass and Sign
 Money and Securities
 Crime
 Employment Practices Insurance
 Equipment Floater
 Installation/Builders Risk
 Electronic Data
 General Liability
 Business Auto
 Non-Owned and Hired Auto
 Sexual Misconduct Coverage
 Directors, Officers and Trustees Coverage (D&O)
 Boiler and Machinery
 Workers Compensation
 Umbrella

Nature of Ministries (Description of Operations)


Use this area for any special comments or coverages which need special attention.


 

  
 

Naperville 630.428.9905 Zion/Beach Park 847.623.5540 Woodstock 815.337.7746