The Highest Quality Professional Liability Insurance Leads Available

Example Lead: Information Request Form

Lead Type: Professional Liability
Date Received: 01/05/2006

Contact Information:
Business Name: Baxter Resnick Str. Eng. Inc.
Contact Name: Bruce Baxter
Address: 1947 Pontius Lane Los Angeles, CA 90025
Phone Number: 310-478-3322
Fax: 310-478-3325
Email: baxter_resnick@baxterresnick.com

Business Information:
Legal Entity: Corporation
Industry: Engineering Services
Nature of business: Structural Engineering
Number of owners: 2
Number of FT emp: 10
Number of PT emp: 0
Number of subs: 0
Year started: 1989 or Earlier
Years of Experience of Owner: 22

Policy Information:
Currently insured for PL?: Yes
If yes, Carrier: St. Paul
Expiration date: 01-31-06
Premium Range: $20,000 - 49,999
Date to go in Effect: 1 Month
Liability Coverage: Less than $1,000,000
Liability Deductible:

Other info your Agent needs to know:



The Highest Quality Professional Liability Insurance Leads Available

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Fill out the form below or call 1-877-601-6678

Lead Information Request Form
* First Name
* Last Name:
  Company:
* Phone:
  Cell Phone:
* Street Address:
* City:
* State:
* Zip Code:
* Email:
  Website:
Years in Business:
 
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