Church Insurance Quote - Insurance Service Center

Church Information

Name*

First Last

Email*

Business Name

Church Address

Street Address City State ZIP Code

We only insure Kentucky and Tennessee

Fax

Year Built

Number of Buildings

Combined Square Footage

Number of Stories

Construction Type

Roof Type

Number of Playgrounds or Sports Field

Annual Payroll

New Policy Start

New Policy Term

Prior Policy Expiration

Prior/Current Carrier

Current Premium

Building Coverage

Contents Coverage

Instruments Coverage

Occurances Coverage

Describe any additional coverages needed

Number of Claims in the past 3 years

Claim Description	Date of Claim	Amount of Claim

Agent Name (Optional)

How Did You Hear About Us?

Preferred Contact Method

Additional Comments