No Obligation Premium Estimate Request Form


At Flag Insurance Services, we understand that your time is valuable.  We have created a simple, two page form for your completion. 


Please return the following by email attachment, fax or regular mail:


1) completed, signed and dated Premium Estimate Request Form


2) copy of your current declarations page (unless you do not have any insurance currently)


3) sample copy of your firm's letterhead.


Return by email attachment to:


Return by fax to:




Return by mail to:


New Business Underwriting

FLAG Insurance Services

84 Court Street

Freehold, NJ 07728





New York Law Firm Premium Estimate Request Form
No obligation Premium Estimate Form for New York Law Firms of 1 - 100 attorneys
NY Premium Estimate Form 09-28-10 b.pdf
Adobe Acrobat document [367.3 KB]

Do you have questions about how to complete the premium estimate request form or do you want to make an appointment in this area?

Call us at 800-548-1063 or use our contact form.