Turner Insurance

I Want a Quote for my Practice

Turner Insurance has package policies available just for dentists! Our program will provide your practice with a comprehensive insurance product with an “A” rated carrier

Name:

Office Address

Street

City, State, Zip

Email:

Daytime Phone:

Evening Phone:

Web site:

Best day and time to meet:

Ony complete if applicable to your operations:

General Liability Limits:

Current Building Value:

Year Building Constructed:

Deductible:

Sprinklered:

Yes No

In town limits?

Yes No

If not, what township?

Business Personal Property Limit:

Business Auto (Complete for each vehicle)

	Year	Make	Model	VIN	Value
1.					.00
2.					.00
3.					.00
4.					.00
5.					.00

Auto Liability Limits:

Deductibles:

Workers Compensation:

Total Payroll - Office Staff :		Number of staff:
Total Payroll - Dentists:		Number of dentists:
Federal Employer ID Number:
Please note: Maximum payrolls for dentists and executive officers are $130,000 per person for corporations and LLC's. Maximum is $43,400 if dentist is a sole proprietor or partnership.

Commercial Umbrella Limit:

Other:

If you have not received a response from us within one business day, please contact us again. Thank you.