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Hot Line: 800-252-2045

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Policies
Claims
- Tender a Claim
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- Tender a Cyber Claim
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CLE/Member Portal

Our Company
Policies
Claims
- Tender a Claim
Cyber Coverage
- Tender a Cyber Claim
Pay Online
CLE/Member Portal

Our Company
Policies
Claims
- Tender a Claim
Cyber Coverage
- Tender a Cyber Claim
Pay Online
CLE/Member Portal

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1 Firm

2 Areas of Practice

3 Claims

4 Coverage

Please fill in the information below and, based on the information you provide, a team member will contact you with an estimated annual premium.
Firm Information
Firm Name*
Contact Person*
Email*
Address*
City*
State*
Zip*
Phone*
Fax
Number of Lawyers in Firm*

Three Major Areas of Practice and Percentages
1. Area of Practice*
1. Percentage*
2. Area of Practice
2. Percentage
3. Area of Practice
3. Percentage

Claims/Discipline Information
Number of reported incidents and/or claims in last 10 years*
Number of disciplinary proceedings before any bar within past 10 years*

Requested Coverage
Effective Date Requested
Date Format: MM slash DD slash YYYY
Limits Requested*
- $100,000/$300,000
- $250,000/$750,000
- $500,000/$1.5M
- $1M/$3M
- $2M/$4M
Deductible Requested*
- $1,000
- $2,500
- $5,000
- $10,000
- $25,000
Date Firm Established*
Date Format: MM slash DD slash YYYY
Existing Prior Acts Date
Date Format: MM slash DD slash YYYY
Firm Currently Insured?*
- Yes
- No

Add each lawyer who is to be insured under this policy

Lawyer Name	Date of Employment (or start date if sole practitioner)	Prior Acts Date with Current Carrier
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There are no Lawyers.

We will contact you via email with an estimated quotation. It is an estimate of premium only and does not constitute approval. This indication is subject to receipt, review, and approval of a completed Lawyers’ Mutual Application. Please visit www.lawyersmutual.com to download an application or to submit a Quick Quote Form. To speak with the Underwriting Department, please call 800.252.2045.

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Lawyer Name*
Date of Employment (or start date if sole practitioner)*
Date Format: MM slash DD slash YYYY
Prior Acts Date with Current Carrier*
Date Format: MM slash DD slash YYYY