Church Quote Request

1
Please select the average weekly attendance of your church (combined between in-person and online).* This field is required.
less than 100
100-500
500-2000
2000-5000
5000+
2
What is the name of your church?* This field is required.
3
Submission Count
4
And what is your name?* This field is required.
First Name
Last Name
5
What is your role at the church?* This field is required.
Pastoral
Administrative
Financial
Stewardship
6
Are you an employee or volunteer?* This field is required.
Employee
Volunteer
7
What phone number can we reach you at to review your quote with you?* This field is required.
Please enter a valid phone number.
8
And your email address?* This field is required.
example@example.com
9
Does your church have a website? If so, please input below:
www.example.com
10
Is your church currently insured?
YESNO
11
Who are you currently insured with?
Brotherhood Mutual
Church Mutual
GuideOne
Mennonite Mutual
Southern Mutual
Grinnell
Selective
12
What's got you shopping for insurance today?* This field is required.
Premium increase
Claims issues
Coverage concerns
Unsatisfied with current agent
Currently uninsured
Starting a new ministry
13
Who makes the final decision regarding insurance at your ministry?* This field is required.
Myself
Board of Directors
14
Alright, is your church a multi-site or a single campus ministry?* This field is required.
Multi-site
Single campus
15
What state are you located in?
16
Give church location(s) address, own/rent, # of buildings on premise & describe buildings (e.g. 4 buildings - church, parsonage, youth building, fellowship hall)
17
What is the mailing address of your church?
18
What year was your church started? (estimate is fine)
19
What is the FEIN of your church?(Federal Employer Identification Number)
20
What denomination is the church?
21
Are you part of any church planting networks or church fellowship networks? If so, please list below:
22
Do you or any of the church's volunteers or employees hold positions within your denomination or network? If so, please describe below
23
How many employees does your church have? Both full and part-time* This field is required.
24
Estimated annual payroll?* This field is required.
25
And the estimated total annual revenue?* This field is required.
26
Does the church require background checks on employees and volunteers?* This field is required.
Yes
No
27
Does the church have a policy for training and equipping volunteers to report incidents of abuse?* This field is required.
Yes
No
28
Has the church completed any major updates within the last 20 years? e.g. roofing, heating/cooling, electrical, plumbing, etc.* This field is required.
Yes
No
Not Sure
29
Ok, Great! We can use this to reduce your insurance cost. Please list each update below.
30
Does the church provide any additional outreach in your community? Please select all that apply
Food pantry
Clothing donations
Medical services
Biblical counseling
Professional licensed counseling on a fee basis
Vacation bible school
Addiction ministry
Meal provision/delivery
31
Are you aware of any insurance claims within the past 3 years? If so, please summarize below, one claim per line.
32
Does the church own a parsonage? If so, how many?
33
Does the church own any rental dwellings? If so, how many?
34
Does the church own any vehicles?
Yes
No
Not sure
35
Please list out the owned vehicles below. Include: Year, Make, Model & VIN & Driver List. Alternatively, you can email this info to jbland@hummelgrp.com or upload them at the end of this form
36
If you have a paper copy of your current policy, our team will contact you to gather a copy for your review. If you have an electronic copy, you can upload it on the next screen. We do not need the full policy, only the coverage highlights for property, liability, auto, work comp or umbrella policies, if they apply.
Ok, got it!
I do not have insurance currently
37
You're practically done! Last thing to do is to upload any files, if you'd like. Upload your current insurance declarations page, business auto, umbrella coverage, work comp, auto driver list, any other pertinent information. If you have nothing to upload, just hit "submit" to complete your quote request.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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