The Atlanta Lawyer January/February 2015 | Page 23

from Insurance Specialists, Inc. Providing Professional Liability Insurance Since 1965 This is a paid advertisement and the Atlanta Bar Association does not endorse or in any way guarantee any of the products or services of this company. Lawyers Professional Liability Insurance Premium Estimate Applicant Firm Information Firm Name Contact Person # of Attorneys in Firm Phone Number Fax Number E-mail Address Street Address (City, State, Zip Code, County) Practice Survey Indicate the percentage of firm income derived from each area of practice. 1. Area of Practice % of Firm Income 4. Area of Practice % of Firm Income 2. Area of Practice % of Firm Income 5. Area of Practice % of Firm Income 3. Area of Practice % of Firm Income 6. Area of Practice % of Firm Income To receive RAPID RATE premium estimate, please complete and return this request to: Insurance Specialists, Inc. - Professional Liability Dept. 305 Carteret Street Beaufort, SC 29902 Phone: (888) ISI-1959 • Fax: [phone] E-mail: [email protected] Please attach a copy of firm letterhead and a copy of policy declarations page (if available). Coverage may be bound only upon submission and acceptance of a fully completed application. Agent Date of Completion