• 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

  • Birthday*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Coverage Needs:

  • In High Net Worth the most useful benchmark is not just the average premium, but rather the median, as it ignores extreme outliers that can falsely inflate the average. Comparing carriers' medians and averages to each other allows an agency to best determine individual insured's alignment but comparing carriers to themselves within different categories, can showcase what factors are most rate impacting.

    The rate impacting factors may or may not align with an agency's overarching carrier needs. Example: Bringing on a carrier whose premium is most impacted by auto exposures is less concerning to agencies with low car(s)/household ratios or if insureds are in rural areas.

  • Endorsement*

  • Coverage Overviews:

    Cyber Family Protection
    Earthquake Employment Practices Liability
    Equipment Breakdown  
  • Effective Date Needed*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Need by Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • - Homeowners

  • Property Type*
  • Occupancy*
  • Earthquake Deductible
  • Construction Type
  • Fire, Water, and Safety (please select all)
  • Additional Home(s)
  • Property Type
  • Occupancy
  • Earthquake?
  • Construction Material
  • Fire, Water, and Safety (please select all)
  • Has the insured had any property claims within the last 5 years?
  • oos: Coverage Needs*

  • - Auto

  • Vehicle(s)*
  • Are they willing to participate in telematics?*
  • Coverage (please enter in the same order as vehicles)*
  • Check all that apply
  • Driver(s) Information*
  • Check all that apply
  • Has the insured had any claims within the last 5 years?

  • - Watercraft

  • Does the Primary Operator hold a USCG license?
  • Is there a paid Captain?
  • Does the Captain hold a USCG license?
  • Regular Operator(s)*
  • Vessel(s)*
  • Coverage Requested (Select all that Apply):
  • Owner/Vessel Has

  • - Valuable Articles

  • - Cyber

  • Learn more about Cyber offerings here

  • - Loss History

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Or add Loss History Individually

  • Claim(s)*

  • - Additional Details

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Should be Empty: