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Discovery Call Intake Form
Follow Our 3 Step Process To Re-Think Your Risk!
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1
Step 1: Upload Payroll Info
Upload an Excel Spreadsheet or PDF showing the Annual Payroll For your Company By Position & Salary
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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2
Step 2: Upload Vehicle Fleet Info
Upload an Excel Spreadsheet or PDF of all your Company Vehicles including Year, Make, Model & VIN
Drag and drop files here
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Max. file size
: 10.6MB
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3
Step 3: Upload Driver Info
Upload an Excel Spreadsheet or PDF of all your drivers including Full Name, Date of Birth & Driver's License #
Drag and drop files here
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Max. file size
: 10.6MB
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4
What Is Most Important To Your Business?
Check All that Apply
Access To Tools & Resources To Mitigate Risk
Access To Expertise To Help Understand Our Insurance Program
Access To Speedy Service
Help Improving Our Insurance Program
Help Lowering Our Total Cost Of Risk
Working With An Advisor To Help our Organization Profitably Scale Our Business
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5
Which type of Commercial Insurance Policy(ies) are you interested in?
Select ALL that apply.
Commercial Auto
General Liability
Property Insurance (Building Coverage or Inland Marine Coverage)
BOP=Business Owner Policy (Includes General Liability + Property)
Worker's Compensation
Cyber Liability
Commercial Umbrella
Professional Liability or Errors & Omissions (E&O)
Management Liability (D&O)
Employment Practices Liability (EPLI)
Other
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6
We need your full name.
*
This field is required.
Provide your First and Last name.
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7
E-mail:
*
This field is required.
example@example.com
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8
Phone Number
*
This field is required.
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9
Additional Information:
Enter any additional information that you feel would help our team better prepare Risk Management Solutions For You
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