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Business Insurance Quote Form

To receive a free quote, call toll free 800-769-2000, ext. 8180. Or fill in the information below. Information is required unless noted as optional. When finished, click the "Submit" button at the bottom of the page.

All fields marked with * are required.


Quote Selection

Select the product(s) for a quote:(Optional)


Contact Information

Please contact NCMIC to inquire about availability of coverage in Florida. 1-800-769-2000, ext 8180 or agents@ncmic.com.

 
 

Is your practice address the same as the mailing address?: *

Address

Please contact NCMIC to inquire about availability of coverage in Florida. 1-800-769-2000, ext 8180 or agents@ncmic.com.

 

Do you have employees? *

 
Practice Information
 

Do your business operations involve growing, storing, selling, dispensing, manufacturing/processing or otherwise providing access to medically-prescribed or recreational marijuana? *

Facility Information

Do you own the building? *

Building Info
 

Is building ownership the same as chiropractic business ownership? *

Building Construction: *

 
 
Updates

Year of last updates to: (Optional)

NCMIC provides the insurance quote based on replacement cost of contents. Please use a dollar amount based on what it would cost to replace the items today if purchased new.

If you have not made any physical improvements to your business location, please state "None".

Coverage and Quote Information

Have you filed a claim for your office insurance in the last 5 years? *

Claims
 

Choose a liability coverage amount: *

Do you currently have Business Owners' Coverage? *

Carrier

Do you have multiple practice locations? *

Other Locations An NCMIC insurance representative will contact you for information about your other locations.
Employee Information

Are owners/principals included? *

Have you had any workers' comp. claims in the past 5 years? *

Workers Comp
 
Patient Data Information

What patient information do you store electronically or on paper? (Check all that apply)*

Which of the following are in place on your business' computer systems? (Check all that apply) *

Which of the following are in place to safeguard personal information stored at your office? (Check all that apply) *

Comments

(maximum 2000 characters)

Once your completed information is received, a representative will contact you.

Questions? Call toll free at 1-800-769-2000, ext. 8180.



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