Lawyers Online Indication Form

General Information

Firm Name *

Year Established

Street *

City *

County

State *

ZIP / Postal Code *

First Name *

Last Name *

Primary Phone Number *

Fax

E-Mail Address *

Application Upload

Current Policy Information

Current Coverage *

No
Yes

Policy Expiration Date

Exclusion Date Retroactive or "Prior Acts Date"

Current Limits

Current Deductible

Deductible Type

Optional Coverages

Hold down the Ctrl Key to make multiple selections.

Current Insurance Carrier

Years of Continuous Coverage

Premium

Current Policy Declarations Page Upload

Attorney Information

Attorney 1

Name of Attorney 1 *

Attorney 1 Date Began Private Practice

Attorney 1 Date Joined Firm

Attorney 1 Status

Attorney 1 Hours Worked per Week

Attorney 1 Individual Retroactive Date

Attorney 2

Name of Attorney 2

Attorney 2 Date Began Private Practice

Attorney 2 Date Joined Firm

Attorney 2 Status

Attorney 2 Hours Worked per Week

Attorney 2 Individual Retroactive Date

Attorney 3

Name of Attorney 3

Attorney 3 Date Began Private Practice

Attorney 3 Date Joined Firm

Attorney 3 Status

Attorney 3 Hours Worked per Week

Attorney 3 Individual Retroactive Date

Attorney 4

Name of Attorney 4

Attorney 4 Date Began Private Practice

Attorney 4 Date Joined Firm

Attorney 4 Status

Attorney 4 Individual Retroactive Date

Attorney 5

Name of Attorney 5

Attorney 5 Date Began Private Practice

Attorney 5 Date Joined Firm

Attorney 5 Status

Attorney 5 Hours Worked per Week

Attorney 5 Individual Retroactive Date

Areas Of Practice: Provide percentages of time devoted during the previous year in each area of practice (Must Total 100%)

General Practice Areas

Admiralty/Marine – Defense

Admiralty/Marine – Plaintiff

Anti-Trust/Trade Regulation

Arbitrator/Mediator

Banking/Financial Institutions

Bankruptcy

Civil Rights/Discrimination

Collections

Construction (Building Contracts)

Consumer Claims (not class action)

Criminal

Entertainment/Sports money mgmt

Entertainment/Sports No money mgmt

Environmental Law

ERISA/Pension/Employee Benefits

Govt. Contracts/Claims

Healthcare – Regulatory Compliance

Immigration/Naturalization

Intellectual Property

International Law

Labor/Employment – Management

Labor/Employment – Employee

Labor/Employment – Union

Lobbying

Local Govt./Municipal (not bonds)

Natural Resources/Oil & Gas

Other (please describe)

Other Desc.

Business Transactions/Corp. Law

Administrative

Formation of Entities

General Contract Negotiation

Mergers & Acquisitions

Secured Transactions

Family Law

Adoption

Divorce – Marital Assets < 1M

Divorce – Marital Assets > 1M

Elder Law

Guardianship/Juvenile

Social Security

Litigation

Class Action/Mass Tort – Defense

Class Action/Mass Tort – Plaintiff

General Commercial – Defense

General Commercial – Plaintiff

Insurance Defense

Personal Inj./Prop Damage – Defense

Personal Inj./Prop Damage – Plaintiff

Personal Inj/Med Mal -Plaintiff

Work Comp – Defense

Work Comp – Plaintiff

Real Estate

Abstracting/Title – Commercial

Abstracting/Title – Residential

Conveyance – Commercial

Conveyance – Residential

Foreclosures & Loan Workouts

Landlord/Tenant

Syndications/Ltd. Partnerships

Zoning & Planning

Taxation

Business

Individual

Tax Litigation

Opinions

Wills, Estate, Trust, Probate

For assets < 1M

For assets > 1M

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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