Accountants & CPAs, Start Your Quote Below

The information provided on this form will be used to provide a non-binding premium indication. Any resulting premium indication does not obligate Hirsch Insurance Brokerage to bind coverage and/or issue an insurance policy. Final premium quotation will be subject completion of an insurance carrier application and underwriting review. Review of the application and subsequent binding approval by the insurance carrier are necessary.

1. General Firm Information

First
Last
Principle Business Address (No P.O. Boxes):
Street
City
County
State
Zip

2. Current Insurance Information

If YES, please complete the current insurance information.

3. Claims History

4. Staff Count

Number of Employees
List all CPA owners, partners, officers, non owner CPA's. Please also provide whether the accountant is a full-time and part-time employee.
First
Last
Accountant #2
First
Last
Accountant #3
First
Last
Accountant #4
First
Last
Accountant #5
First
Last
Further Information

5. Firm Revenues

6. Accounting Services Provided

Estimated revenue percentages derived from services offered.
Enter a number as a percentage . Total of all categories must equal 100%. Don't worry – it will be added up for you.

7. Optional Coverage Requested-Subject to Underwriting Review

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