• General Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date business was started*
     - -
  • Do you operate any other type of business or own any other building than listed on this form?*

  • Contracting Operations

  • Do you have an attorney who evaluates your contracts?*

  • Location / Building Information

  • Do you own the office space?*
  • Is this a Brand New Business Venture?*

  • Insurance Carrier History

  • Have you had insurance coverage declined, cancelled or non-renewed during the last 3 years?*

  • Why do you need my Declaration Page?

  • Majdas Touch Insurance, Inc. is an Insurance Brokerage. We use your Declaration Page & Drivers License to obtain pricing on your behalf. We have access to 368 different insurance companies, we are licensed nationwide, and we act as a "personal shopper" of insurance. We obtain price quotes from all the available companies and find you the lowest prices with the best coverage, matching exactly what you have now, apples to apples. If we feel that you are under or often times even over insured, we will discuss coverage options with you at the time we provide you with the best pricing available. First, it is important to us to provide you with pricing matching "exactly what you have now", so that you can determine what your true savings are, and whether you want to sign up with us or not. If you obtain coverage through our office, our founder Majda Baltic will become your Agent of record meaning we will be your point of contact with whichever company you chose to proceed with regarding policy changes, proof of insurance copies, payments, coverage questions, claims, etc. The most valuable asset by doing business with us is that if your insurance company raises rates, or if you are ever unhappy with the carrier for any reason at all, we can always shop your rates time and time again. There is no limit to shopping and we get to remain your Agent for life - that is, if you will have us!


    *Extra savings perk: Having proof of prior insurance gives us the ability to add an additional discount averaging about 30%!!!


  • Do you want Cyber Liability?*

  • Cyber Liability

  • Do you, or an outsourced firm, back up your data and systems at least once a week, and store these backups in an off-site location?*
  • Do you have anti-virus software and firewalls in place and that are regularly updated (at least quarterly)?*
  • After inquiry of the “Control Group”, as defined, are you aware of any or have any grounds for suspecting any circumstances which might give rise to a claim?*
  • Limit of Liability*
  • Do you want Property Insurance?*

  • Property

  • Do you rent or loan equipment to others?*

  • Contents may include, but is not limited to: Leasehold Improvements, Leased Property, Inventory, Furniture/Fixtures, Equipment, Printed Materials, Consumables, and Property of Others in Your Care. Please consult your lease requirements when choosing the coverage and limits for this location.

  • Do you want Crime Insurance?*

  • Crime Insurance

  • Do you require subcontractors to have insurance, and do you obtain Certificates of Insurance?*
  • Do you want Workers Compensation Insurance?*

  • Workers Compensation

  • Rows
  • Are you interested in Business Auto Insurance?*

  • Business Auto

  • Do you rent vehicles for business use?*
  • Do employees use personal vehicles for business?*

  • Vehicle Schedule

  • Driver Schedule

  • Other Coverage To Consider

  • Select YES or NO for the optional coverage below.

  • Umbrella Liability Policy*
  • Employee Benefits Liability*
  • Employment Practices Liability*
  • Directors & Officers Liability*
  • Errors & Omissions Professional Liability*
  • Fiduciary Liability*

  • My Products

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    Submission Fee. *Non-refundable
    Submission Fee

    *Non-refundable

    $25.00$25.00
      
    Total
    $0.00$0.00
    Debit or Credit Card

  • You are not required to pay for services or utilize our office to secure insurance services in exchange for obtaining your insurance policy. While you have chosen to collaborate with Majdas Touch Insurance, Inc., you are under no obligation to do so, and you retain the freedom to explore other brokerages without incurring any fees. The decision to continue paying this fee is entirely voluntary, and you are making it of your own accord and volition.

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