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Register 2017-03-14T12:10:39+00:00

Applicant Information

NOTICE: THE PURCHASE OF THIS INSURANCE MUST BE EFFECTUATED NO LATER THAN SIXTY (60) DAYS AFTER SERVICE OF SUIT. PLEASE READ THE ENTIRE POLICY CAREFULLY AND CONSULT WITH YOUR BROKER/AGENT OR OTHER PROFESSIONAL TO THE EXTENT YOU DO NOT UNDERSTAND ANY TERMS OR CONDITIONS OF THE POLICY.

Please list all attorney names and license numbers.


TYPES OF LITIGATION:














Questionaire for Prospective Law Firm


Address of Home Office:


Disclosure Notification:

Each Law Firm Case will be individually evaluated and prequalified by our Wholesaler based on multiple factors including number of cases and attorneys registering, average litigaton each year verified through IRS filings and a minimum of 50% eligible cases to be insured.

All policies will be bound within 15 days of qualification and engagement.