Professional Liability (E&O) Application for Accountants
Please complete the application below. To speak with a licensed agent please call 877-831-9462
Business Name
*
Contact Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Do you consent to receive text messages regarding your inquiry?
*
Yes
No
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website
Year Established
*
Do you currently have errors and omissions insurance - if yes, please provide details below or email current declaration page to Service@ProfessionalLiability.pro
*
Yes
No
Any previous claims in the last 5 years, disciplinary actions, or knowledge of potential claims?
Yes
No
Please provide gross income for the following years:
*
Back
Next
For all services provided, indicate the approximate percentage of the firm’s prior fiscal year 12 month revenue (Or estimate for next 12 months if new business)
Are engagement letters used with all clients?
Yes
No
Additional Information (Current insurance information, details on any claims, other services provided, etc.). You can also email Service@ProfessionalLiability.pro if you prefer.
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