Get a Quote: Accountants - Professional Services Plan

Full Name*

Firm/LLC Name*

Firm Address*

Street Address Address Line 2 Country

Work City & State*

Work County & Zip Code*

Work Phone*

Work Email*

Insurance History

Please answer the following.

Current Carrier*

Current Expiration Date*

Prior Acts Date*

Current Limits*

Current Deductible ($)*

Claims History

If any, please complete a claim supplement for each claim or incident.

In the past 5 years, #claims/incidents reported*

If any, please e-mail loss run history to [email protected]

In the past 5 years, #grievances filed*

CPA Information

This section is about the CPAs in your firm. Please answer the following.

Provide Annual Revenue ($)*

Total # of CPAs in the firm*

Non-CPA Information

This section is about the all other Accounting and/or Tax Professionals s in your firm. Please answer the following.

Total # of Degreed Accountants*

Enter number of CPAs with more than 6 years of work history

Total # of Other Professionals with Billed Time*

Total # of non-CPAs (Accounting/Tax Professionals)*

Total # of Administrative Staff, Owners, Partners (non-Accounting Professional)*

Area of Practice Information

What % of the Firm’s revenue is derived from the areas listed below? Please list the % of for each area of practice. Percentage total must equal 100%

Administrator or ERISA Trustee( %)*

Engagement Letter Used*

Yes
No

Audit: Non-Profit (%)*

Engagement Letter Used*

Yes
No

Audit: Public (%)*

Engagement Letter Used*

Yes
No

Audit: Other (%)*

Engagement Letter Used*

Yes
No

Bookkeeping/Write Ups/Payroll Processing (%)*

Engagement Letter Used*

Yes
No

Business Valuations (%)*

Engagement Letter Used*

Yes
No

Compilations (%)*

Engagement Letter Used*

Yes
No

Consulting (%)*

Engagement Letter Used*

Yes
No

Forensic Accounting (%)*

Engagement Letter Used*

Yes
No

Hardware Software Consulting / Sales (%)*

Engagement Letter Used*

Yes
No

Management Advisory Services (%)*

Engagement Letter Used*

Yes
No

Personal Financial Planning (%)*

Engagement Letter Used*

Yes
No

Reviews (%)*

Engagement Letter Used*

Yes
No

Securities (%)*

Engagement Letter Used*

Yes
No

Tax: Business(%)*

Engagement Letter Used*

Yes
No

Tax: Individual (%)*

Engagement Letter Used*

Yes
No

Tax: Other (%)*

Engagement Letter Used*

Yes
No

Trustee Services / Executor(%)*

Engagement Letter Used*

Yes
No

Other (%)*

Engagement Letter Used*

Yes
No

Area of Practice Percentage Total Must Equal 100%

We may need additional information to provide an estimate.

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INSURANCE ESTIMATE FOR ACCOUNTANTS

Please answer the following. We will provide a quote estimate and details of the coverage to your preferred contact method.

Insurance History

Claims History

CPA Information

Non-CPA Information

Area of Practice Information