CHURCH INSURANCE APPLICATION

CHURCH INSURANCE APPLICATION for Insurance
Legacy Insurance Agency ,

1340 Environ Way, 3rd Flr

Chapel Hill, NC 27517

email: ameer@legacyinsure.us

Text / Call : 919-903-9164
Applicants Name
Please enter the name of the non-profit organization seeking Insurance
Contact Person / Name of the Officer
Physical Location Address
Mailing Address
If the Mailing address is same as Physical Address , please enter " Same"
Phone No.
Format: (000) 000-0000.
email Address
Effective Date of Coverage Needed
ANSWER ALL QUESTIONS-IF THEY DO NOT APPLY, INDICATE "NOT APPLICABLE" (N/A)
1 Advise the type of governing structure in the church ie executive board council executive director etc
Number of Clergy / Imams / Priests
Number of Volunteers
Number of Parsonage
If not Applicable , please enter "N/A"
Date established

MonthDayYear
Date
Approximate Size of congregation
No of acres of Offsite Cemetery
If not Applicable , please enter "N/A"
LIMITS OF INSURANCE REQUESTED
Building Value
Please enter the value of the Building
Please schedule an appointment
Please upload the existing Full Policy Dec pages, so that we can decipher the information needed for quoting effectively

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CHURCH INSURANCE APPLICATION for Insurance