In order to provide the most accurate estimate of your firm’s ALPS insurance premium we need to collect a little information from you first. The estimate should take no more than ten minutes of your time. Thank you for considering ALPS for your malpractice insurance.



Please tell us about where your firm is located and how we can contact you. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com


Answers required to receive an estimate *

Firm Name:
Address:
City:
State:
Zipcode:
Phone:
    Fax:
Email:
    Website:

Please tell us about your firm’s insurance history so we get an idea of how much coverage you’ll need. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com


Answers required to receive an estimate *

Requested Policy Effective Date (MM/DD/YYYY):
Requested Limits (Per Claim/Aggregate):
Requested Deductible:

Leave the following three questions blank if your law firm does not currently have a policy.
Current Retroactive Date (MM/DD/YYYY):
Current Malpractice Insurance Provider:
Current Annual Premium: $

Please tell us about your firm's area(s) of practice. This information is required to receive an estimate. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com


AOP information is required to receive an estimate.

% Admirality/Maritime% Entertainment/Sports% Oil/Gas
% Anti-trust/Trace Regulation% Environmental% Patents
% Arbitration/Mediation% Estate/Probate/Wills/Trusts% Copyright/Trademark/Service Mark
% Bankruptcy% ERISA/Employee Relations% Public Utilities
% Civil Litigation-Plaintiffs% Civil Litigation-Defendants% Real Estate
% Financial Institutions/Banking% Gaming/Casino/Representation% Securities Exempt/Bonds
% Collection/Repossession% Government/Municipal% Securities/Registered Offerings
% Corporation/Business% Immigration% Social Security
% Mergers and Acquisitions% International Law% Taxation
% Criminal% Labor Law/Employee Relations% Workers Compensation
% Domestic Relations% Natural Resources/Water Rights% Other - Describe Below
    Other Description* Required if Other % is > 0
Total (should equal 100%):    %

Please tell us a little general information about your firm so we get an idea about your firm’s composition and practices. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com


Answers required to receive an estimate *

Firm Established Date (MM/DD/YYYY):
Total Number of Paralegals/Law Clerks:
Total Number of Clerical:
Attorney Insurance Contact:
Non-Attorney Insurance Contact:

Do you sue for fees?
If you are a newly established firm, please answer questions in terms of what you plan to do.

Please tell us a little about the attorneys in your firm so we know who is being covered. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com


Adding at least one attorney is required to receive an estimate.

Total Number of Attorneys in the Firm:


For each attorney, click the “Add Attorney” button below to provide specific information on the firm’s attorneys.

You must click “Save” to save your updates in the Attorney Details popup.



Please tell us about your firm's claims history. If you need assistance, please contact an ALPS representative at 800-367-2577 or learnmore@alpsnet.com


Answers to all four of the following questions are required to receive an estimate.


Has any claim or suit been made against you or any other current or former member of this Firm or any Predecessor Firm in the last five (5) years?

Are you or any member of the Firm aware of or have knowledge of any fact, circumstance, act, error, or omission that could reasonably be expected to be the basis of a claim against any current or former Attorney in the Firm or any Predecessor Firms, regardless of the merit of such claim?

Has any current or former Attorney of the Firm ever been refused admission to practice, disbarred, or suspended from practice?

Has the Firm’s coverage ever been non-renewed, discontinued, cancelled, rescinded, or declined by any professional liability insurance company? (MISSOURI RESIDENTS, DO NOT ANSWER)