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About
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Contact
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Gwyneth Miller
Happiness Coordinator
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If you want to specify a mailing address different from your location address, please let us know in your Discovery call.
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RiskWell is authorized to communicate with me using the information provided for the purpose of delivering the requested information or solution. This communication may include phone, text or email. This authorization may be revoked at any time.
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Start Your Multifamily Property Quote:
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*
" indicates required fields
1
Contact Info
2
Property Info
3
Wrap-Up
Are you a current client of RiskWell?
No, I will be a new client
Yes, I am a current client
Your Name
*
First
Last
Entity name that owns/will own the property
*
Preferred Phone Number
*
Preferred Email
*
Your Mailing Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Property address to be quoted:
*
If you need a quote for more than one property right now, we will gather that information on your Discovery Call.
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
How many residential units on the property?
Do you have a lienholder/mortgagee for this property?
We will collect this information later
Yes, I have a lienholder/mortgagee
No, I don't have a lienholder/mortgagee
Do you need a companion FLOOD INSURANCE proposal for this property?
No
Yes
How did you first hear about RiskWell?
Personal Referral
Google Search
McKinney Chamber of Commerce
Local event
Facebook Group/Post
YouTube video
Word of mouth
Who referred you to us?
*
What else do we need to know to deliver you an outstanding experience?
Please upload all relevant documents here:
Drop files here or
Select files
Max. file size: 10 MB, Max. files: 3.
Communication Consent
*
RiskWell is committed to respecting our current and future clients' privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you using phone, text and email as needed.
You may opt-out of all future communication at any time by making your preferences known to us.
RiskWell operates by the simple rule of "treat other people the way you want to be treated."
I authorize RiskWell to communicate with me using the information provided on this form for the purpose of assisting with my insurance program..
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*
" indicates required fields
1
Contact Info
2
Property 1 Info
3
Property 2 Info
4
Property 3 Info
5
Property 4 Info
6
Wrap-up Info
How many separate properties do you need a quote for right now?
*
If you need quotes for more than 15 properties, please email REI@riskwell.com and we will personally assist with your request.
1
2
3
4
Are you a current client of RiskWell?
*
No, I'm a new client
Yes, I'm a current client
What effective date do you want for your new insurance?
*
Please note, we are not able to backdate coverage. Today's date is the first available day for coverage to begin.
Month
Day
Year
Your Name
*
First
Last
Your Date Of Birth
*
Month
Day
Year
Is the property held in your personal name or another legal entity (LLC, etc...)
*
Held in my personal name
Held in another entity (LLC or other)
Entity Name
*
Phone Number
*
Email
*
Mailing Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Physical Address - Property 1
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
County - Property 1
Building Type - Property 1
*
*Please note we are not able to provide coverage for mobile manufactured homes*
Single Family Residence
2-4 Units
Condo
Townhouse
# Of Units - Property 1
*
Tell us the number of units that you own/need coverage for.
Intended Use - Property 1
*
Long-Term Rental
Flip/Rehab
Short-Term Rental (AirBNB/VRBO)
Vacant
Building Coverage Amount Needed ($) - Property 1
*
For a "flip" property, use the purchase price + your renovation estimate to determine the property coverage amount.
Monthly Rent - Property 1
*
Purchase Method - Property 1
*
Conventional Purchase
Creative Financing Method
Creative Financing Method - Property 1
*
Sub 2
Seller Finance
Wholetail
Policy Payment Method - Property 1
*
Note that if you select "title company or escrow account" you will be required to enter lender/mortgagee information.
I'm paying for this policy directly
I'm paying through a title company or escrow account
Lender/Mortgagee - Property 1?
*
Yes, there is a lender/mortgagee
No, there is not a lender/mortgagee
Lender/Mortgagee Name - Property 1
*
Please provide the full name of the lender.
Lender/Mortgagee Email - Property 1
*
Input the primary contact email for the lender/mortgagee
Lender/Mortgagee Mailing Address - Property 1
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Full name and mailing address for underlying seller - Property 1
*
Physical Address - Property 2
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
County - Property 2
Building Type - Property 2
*
Single Family Residence
2-4 Units
Townhouse
Condo
# of units - Property 2
*
Intended Use - Property 2
*
Long-Term Rental
Flip/Rehab
Short-Term Rental (AirBNB/VRBO)
Vacant
Building Coverage Amount Needed ($) - Property 2
*
For a "flip" property, use the purchase price + your renovation estimate to determine the property coverage amount.
Monthly Rent - Property 2
*
Purchase Method - Property 2
*
Conventional Purchase
Creative Financing Method
Creative Financing Method - Property 2
*
Sub 2
Seller Finance
Wholetail
Policy Payment Method - Property 2
*
Note that if you select "title company or escrow account" you will be required to enter lender/mortgagee information.
I'm paying for this policy directly
I'm paying through a title company or escrow account
Lender/Mortgagee - Property 2?
*
Yes, there is a lender/mortgagee
No, there is not a lender/mortgagee
Same Lender/Mortgagee For Property 2 As With Property 1?
Yes, same lender
No, different lender
Lender/Mortgagee Name - Property 2
Please provide the full name of the lender.
Lender/Mortgagee Email - Property 2
Input the primary contact email for the lender/mortgagee
Lender/Mortgagee Mailing Address - Property 2
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Full name and mailing address for underlying seller - Property 2
*
Physical Address - Property 3
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
County - Property 3
Building Type - Property 3
*
Single Family Residence
2-4 Units
Condo
Townhouse
# of units - Property 3
*
Intended Use - Property 3
*
Long-Term Rental
Flip/Rehab
Short-Term Rental (AirBNB/VRBO)
Vacant
Building Coverage Amount Needed ($) - Property 3
*
For a "flip" property, use the purchase price + your renovation estimate to determine the property coverage amount.
Monthly Rent - Property 3
*
Purchase Method - Property 3
*
Conventional Purchase
Creative Financing Method
Creative Financing Method - Property 3
*
Sub 2
Seller Finance
Wholetail
Policy Payment Method - Property 3
*
Note that if you select "title company or escrow account" you will be required to enter lender/mortgagee information.
I'm paying for this policy directly
I'm paying through a title company or escrow account
Lender/Mortgagee - Property 3?
*
Yes, there is a lender/mortgagee
No, there is not a lender/mortgagee
Same Lender/Mortgagee For Property 3 As With Property 1?
Yes, same lender
No, different lender
Lender/Mortgagee Name - Property 3
Please provide the full name of the lender.
Lender/Mortgagee Email - Property 3
Input the primary contact email for the lender/mortgagee
Lender/Mortgagee Mailing Address - Property 3
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Full name and mailing address for underlying seller - Property 3
*
Physical Address - Property 4
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
County - Property 4
Building Type - Property 4
*
Single Family Residence
2-4 Units
Condo
Townhouse
# of units - Property 4
*
Intended Use - Property 4
*
Long-Term Rental
Flip/Rehab
Short-Term Rental (AirBNB/VRBO)
Vacant
Building Coverage Amount Needed ($) - Property 4
*
For a "flip" property, use the purchase price + your renovation estimate to determine the property coverage amount.
Monthly Rent - Property 4
*
Purchase Method - Property 4
*
Conventional Purchase
Creative Financing Method
Creative Financing Method - Property 4
*
Sub 2
Seller Finance
Wholetail
Policy Payment Method - Property 4
*
Note that if you select "title company or escrow account" you will be required to enter lender/mortgagee information.
I'm paying for this policy directly
I'm paying through a title company or escrow account
Lender/Mortgagee - Property 4?
*
Yes, there is a lender/mortgagee
No, there is not a lender/mortgagee
Same Lender/Mortgagee For Property 4 As With Property 1?
Yes, same lender
No, different lender
Lender/Mortgagee Name - Property 4
Please provide the full name of the lender.
Lender/Mortgagee Email - Property 4
Input the primary contact email for the lender/mortgagee
Lender/Mortgagee Mailing Address - Property 4
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Full name and mailing address for underlying seller - Property 4
*
Do you need a companion FLOOD INSURANCE quote for this property?
*
Yes, please help me get a flood quote
No, I am declining the offer of a flood quote
How did you first hear about RiskWell?
Personal Referral
Google Search
McKinney Chamber of Commerce
Local event
Facebook Group/Post
YouTube video
Word of mouth
Who referred you to us?
*
If this is a Rehab/Flip, are you acting as your own General Contractor for your deals?
*
Your property insurance program DOES NOT cover construction liability. You need General Liability Insurance even if you're only acting as a GC on your own deals.
No, I am not acting as my own GC for my deals.
Yes, I'm my own GC. Please help me get General Liability Insurance for that exposure.
Yes, I'm my own GC. I already have General Liability Insurance for that and don't need your help.
What else do we need to know to deliver you an outstanding experience?
Communication Consent
*
RiskWell is committed to respecting our current and future clients' privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you using phone, text, email and ringless voicemail as needed.
This consent has no time restriction and is offered in perpetuity. You may opt-out of all future communication at any time by making your preferences known to us.
RiskWell operates by the simple rule of "treat other people the way you want to be treated."
I authorize RiskWell to communicate with me using the information provided on this form for the purpose of assisting with my insurance program..
CLOSE
Private Client Proposal Request
"
*
" indicates required fields
Are you a current RiskWell Client?
*
No, I will be a new client
Yes, I'm a current client
What are you looking for help with? Check all that apply:
*
If you want us to deliver a top to bottom review of all of your personal insurance needs, please select "Everything."
Everything
Home & Auto
Specialty Vehicle
Rental Property (Landlord Insurance)
What is your main reason for contacting us?
*
Someone told me RiskWell is great!
Buying a house
Buying a vehicle
Bad claim experience somewhere else
Bad service experience somewhere else
Unhappy with current price
Just curious what you can do for me
What effective date do you want for your new insurance?
*
Month
Day
Year
Name
*
First
Last
Phone Number
*
Email
*
Date Of Birth
*
Month
Day
Year
What is your education level?
Discounts may be available for qualified education levels
High school diploma or equivalent
Undergraduate degree
Graduate degree
Doctoral degree (M.D., J.D., etc.)
Other
What is your occupation?
Discounts may be available for certain occupations
Property Address For Quote
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
What is the estimated year of most recent roof replacement?
*
Drivers Information
Click the "+" button to add additional drivers' info
First Name
Last Name
Date Of Birth
D.L. Number
Add
Remove
Vehicles Information
Click the "+" button to add additional vehicles' info
Year
Make
Model
Vehicle ID (VIN)
Add
Remove
How did you first hear about RiskWell?
Personal Referral
Google Search
Word of mouth
Facebook Page/Post
YouTube video
Local event
Who referred you to us?
*
Anything else we need to know?
You may upload files here
It is extremely helpful if you can upload copies of your current insurance policies. Our loyalty is to you in this quoting process, not any particular company.
Drop files here or
Select files
Max. file size: 98 MB, Max. files: 5.
Communication Consent
*
RiskWell is committed to respecting our current and future clients' privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you using phone, text and email as needed.
You may opt-out of all future communication at any time by making your preferences known to us.
RiskWell operates by the simple rule of "treat other people the way you want to be treated."
I authorize RiskWell to communicate with me using the information provided on this form for the purpose of assisting with my insurance program..
CLOSE
Oops! We could not locate your form.
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What do you need help with?
*
Business Insurance
Real Estate Investor Insurance
Personal Insurance
What kind of property is this?
*
Rental property (1-4 units)
Flip (Builder's Risk)
Multifamily (5+ units)
Commercial
Other
Property address you need quoted
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Who is listed as owner of the property?
*
You or another individual
An entity (LLC, etc...)
Your name
*
First
Last
Legal name of entity that owns this property
*
Legal name of business
*
Phone
*
Email
*
CLOSE
"
*
" indicates required fields
Step
1
of
3
- Intro
33%
Are you a current RiskWell Client?
*
No, I will be a new client
Yes, I'm a current client
Your Name
*
First
Last
What is the legal name of your business entity?
*
Is your DBA name different from your legal entity name?
No
Yes
Your DBA (Doing Business As) name
Your Federal EIN / Tax I.D. Number (if you have one)
(XX-XXXXXXX)
Your Preferred Phone Number
*
Your Preferred Email
*
Your mailing/correspondence address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
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Texas
Utah
U.S. Virgin Islands
Vermont
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
What are you looking for help with? Check all that apply:
*
If you want us to provide a top to bottom review of your business insurance needs, please select "Everything."
Everything
Business Owner Package Policy
General Liability
Commercial Property
Workers Compensation
Commercial Auto
Commercial Umbrella
Bonds, Equipment, Other, Etc.
What effective date do you want for your new insurance program?
*
Month
Day
Year
What is your main reason for reaching out to us now?
I am shopping my upcoming policy renewal
I hear you guys are awesome!
Unhappy with my current agent/broker
Unhappy with a recent claim experience
Just curious what RiskWell can do for me
Is your location address different from your mailing address?
*
No, they are the same
Yes, my location and mailing addresses are different
Location Address Needing Coverage
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Briefly describe your business operations:
*
What is your projected gross revenue for the upcoming 12 months?
*
How many employees does your business have?
0
1-4
5-10
11-50
More than 50 employees
What is your projected total payroll for the upcoming 12 months?
*
Does your business own or lease your physical location?
Lease
Own
Does your business OWN or LEASE any automobiles or mobile equipment?
No, we don't OWN or LEASE vehicles or mobile equipment
Yes, we OWN vehicles or mobile equipment
Yes, we LEASE vehicles or mobile equipment
Yes, we both OWN and LEASE vehicles or mobile equipment
How did you find out about RiskWell?
Personal Referral
Google Search
McKinney Chamber of Commerce
Local event
Facebook group/post
YouTube video
Word of mouth
Who referred you to us?
*
Please share any remaining info/details that will help us deliver you a great experience
You may upload files here
It is extremely helpful for this process if you're able to share current policy documents with us at the beginning. Since we are an independent brokerage, our loyalty is to you, and not any particular company.
Drop files here or
Select files
Max. file size: 98 MB, Max. files: 5.
Communication Consent
*
RiskWell is committed to respecting our current and future clients' privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you using phone, text, email and ringless voicemail as needed.
This consent has no time restriction and is offered in perpetuity. You may opt-out of all future communication at any time by making your preferences known to us.
RiskWell operates by the simple rule of "treat other people the way you want to be treated."
I authorize RiskWell to communicate with me using the information provided on this form for the purpose of assisting with my insurance program..
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