Phone: (972) 235-3030
Toll-Free: (866) 900-RISK

Your Specialists

Jerry Brunker, CPCU, ARM - EXT 170

Brett Byland, ARM - EXT 110

About 10 mins to complete application.

Get A Quote

PLEASE BE AWARE, in order for us to provide an accurate quote, ALL QUESTIONS must be answered. If you are unsure, please answer to the best of your knowledge.

Firm Name
Contact Name
Street Address


Underwriting Information
1. What is the nature of your business?

2. Is the business a
Partnership or
Sole Proprietorship?
3. How many owners are there?
4. How many employees are there (including owners)?
5. What is the gross annual payroll amount?
6. What is the total annual gross revenue or sales?
7. What is the Federal Employer ID Number?
Umbrella Liability Information
8. What limits of liability (in millions) do you desire?
Coverage Information
9. Who is your current insurance company?
10. What is your expiration date?

Are there any questions, comments or additional coverage required?

All information provided is confidential and will be used soley to obtain an indication for coverage. Coverage cannot be bound from this information sheet.

RISKPRO® is a registered trademark of RISKPRO Insurance Agency, LLC