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Book Publisher Business Insurance Quote Form

General Information
Your name:
Company name:
Location address:
City:
State:
ZIP:
Phone:
Fax:
E-mail:
URL:
Description of Operations
Type of operations:
Description of operations
Type of entity
Date established
Fiscal period
Gross annual income (from last fiscal period)
Total income from operations other than publishing
(e.g., speaking 25%; broadcasting 5%; consulting 10%, etc.)
Number of original titles
Number of titles distributed for others
Genre
(textbook, how-to, spiritual, sciences, etc.)
Are publications reviewed by an:

Attorney?
Peer Group?

Have there been any claims or situation that might lead a claim?
Yes No
Current errors & omissions carrier: 
Expiration date: Premium: 
Current general liability carrier:
Exp. Date: Premium:

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