*Indium Commercial Submissions

Your Name*

First NameLast Name
Your Email*
example@example.com
Your Phone Number
Please provide a text enabled phone number if you would like to opt-in to texting about this inquiry.Format: (000) 000-0000.
By checking this box, I consent to receive text messages related to insurance inquiries, quotes, policy, and service updates from Indium. You can reply STOP to opt out at any time. Messages and data rates may apply. Message frequency will vary. Reply HELP to (614)942-1460 for assistance. For more information, refer to our Privacy Policy and SMS Terms and Conditions on our website
I consent
Agency Name*
YesNo
Insured Business Name*
Effective Date*

MonthDayYear
Quote Need by Date*

MonthDayYear
Industry/Sector:*
You MUST SELECT a NAIC Code/pre-populated answer
NAIC Industry/Sector:*
You must select a valid NAIC
(Hidden) Digital Submission Value
Target Premium*
If you do not know an exact target, please include the insured's current premium
Market Status*
This insured is eligible for Digital Brokerage Submissions. Indium has partnered with 8 carriers across 100+ markets to support agencies on small commercial ($10K or less target premium). To read more about this, please check out this page.Carrier(s) will appear below if this is a prioritized industry/sector for them. Agencies are not required to participate. This is an opportunity to work more closely with the carriers to assess the viability of an appointment; if an agency declines, standard submission guidelines will be followed.

Please select ONLY 1 carrier from below if you would like to proceed with a Digital Brokerage Submission:
(Hidden) Digital Submission Selection
Travelers
CNA
(Hidden) TravCal
(Hidden) CNACal
Hanover
Liberty Mutual
(Hidden) HanoCal
(Hidden) LimuCal
Next
WeSure
(Hidden) NextCal
(Hidden) WeSureCal
Coterie
Lio
(Hidden) CoterieCal
(Hidden) LioCal
I understand
UmbrellaWorkers CompensationInland MarineGeneral LiabilityCommercial AutoCommercial PropertyManagement LiabilityProfessional LiabilityGarage
Please attach Acords, an Exposure Workbook or SOVs for applicable lines of business*

Cancelof
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Commercial: Contact & Basic Information
Primary Contact for Insured*

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Insured Website*
if the insured does not have one, please enter "www.none.com"
Business Type

🚨 Loss History ☢️

***Agencies that are unresponsive after submission or have critically low bind rates will be required to provide loss history upon submission to improve efficiency for fellow agency members, carriers, and the Indium team.*** Whether required or not, loss history helps expedite a submission.
Upload Loss Runs or No Known Loss Letter

Cancelof
OR add Loss History Individually
Claim(s)
YesNo
YesNo

Please share any additional details/description of operations*
Should be Empty:

Commercial: Contact & Basic Information

🚨 Loss History ☢️

OR add Loss History Individually