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Church Questionnaire


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.

CONTACT INFO
Name of the Church or Religious Organizations
Required
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
Pastor's Name
Last Name
Required
First Name
Required
E-Mail Address
Required
Primary Phone Number
Required
Alternate Phone Number
Optional
Additional Information
Current Insurance Provider
Optional
Current Policy Expiration Date
Required
/ /
Expiring Policy Annual Premium:
Optional



Underwriting Questions
Age of the Sanctuary
Required
Square Footage of Location
Optional
Construction type
Optional
Year of last roof replacement
Required
Submission Validation
Required
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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.