Church Quote Form

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Church Information

Church Name *

Pastor's Name *

Phone Number *

Pastor's E-Mail Address

Church Mailing Address *

City *

State *

ZIP / Postal Code *

Contact Information

First Name *

Last Name *

Primary Phone Number *

E-Mail Address *

Current Information

Church Property Address *

City *

State *

ZIP / Postal Code *

# of Full-Time Employees *

# of Part-Time Employees *

Annual Payroll (Excluding Pastor) *

Pastor's Payroll

Date Pastor Took Over *

# of Active Members *

Desired Amount Of Coverage

Buidling *

Contents *

Sign *

Steeples *

Building Information

Construction Type *

If "Other", please explain

Year Built *

Square Footage *

Roof Type *

# of Stories *

Seating Capacity *

Building Updates

Air Conditioner/Heating *

If "Yes", when

Exterior Paint *

If "Yes", when

Plumbing *

If "Yes", when

Roof *

If "Yes", when

Wiring *

Type of Wiring *

Electrical System *

Montiored Alarm System *

Sprinkler System *

Coverage Information

Current Coverage *

If "Yes", Carrier name

Coverage Amount

Expiration Date

Expiring Policy Premium

Any prior losses *

If "Yes", when, amount and type of loss

Additional Information

Any Church Owned Vehicles *

How did you hear about us? *

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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