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Please contact our office at 800-336-5422 if you are not eligible for this program

Please contact our office at 800-336-5422 if you are not eligible for this program-2025

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The document is an Express Application for Accountants Professional Liability Insurance from Great American Assurance Company. It outlines eligibility criteria, required information for applicants, premium payment options, and fraud warnings. Applicants must confirm their eligibility by answering a series of true/false statements related to their firm's operations and history. The document also includes details on premium rates based on the firm's revenue and provides instructions for submitting the application.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Firm Name and Contact Name in the designated fields. Ensure accuracy as this information is crucial for communication.
Fill in your Street Address, City, County, State, and Zip Code. If you have a separate mailing address, note it in the margin.
Provide your E-Mail Address and Website Address. This allows for electronic communication regarding your application.
Indicate the Date Established and Phone Number. If applicable, include your Fax Number.
Select whether you prefer to receive an electronic copy of your policy by checking the box provided.
Complete the section regarding Total # of Professionals and Desired Effective Date. Make sure to circle your preferred premium payment option.
Review Statements 1 through 9 carefully and mark 'True' or 'False' as applicable to ensure eligibility for the program.
Finally, sign and date the application at the bottom before submitting it through our platform.

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