Tech & Office Business Insurance Quote | Advantixx Insurance Group

Applicant Information

Business Legal Name*

DBA / Trade Name (if applicable)

FEIN / Tax ID*

Entity Type*

Business Address*

City*

State*

ZIP Code*

Business Phone*

Contact Email*

Contact Person / Owner Name*

Title / Position

Year Business Established*

Years Under Current Ownership*

Website URL

Technology Operations

Primary business type*

Describe your primary products and/or services in detail*

0/500

Annual Gross Revenue ($)*

Annual Payroll ($)*

Full-Time Employees*

Part-Time Employees

Independent Contractors

Do you develop custom software for clients?*

YesNo

Do you provide IT consulting or managed services?*

YesNo

Do you host client data or applications on your servers?*

YesNo

Do you store, process, or transmit personally identifiable information (PII)?*

YesNo

Do you store, process, or transmit protected health information (PHI/HIPAA)?*

YesNo

Do you store, process, or transmit payment card data (PCI)?*

YesNo

Estimated number of client records stored

Do you have a formal written cybersecurity policy?*

YesNoIn Progress

Do you conduct annual penetration testing?*

YesNo

Do you use multi-factor authentication (MFA) for all systems?*

YesNoPartial

Do you have a data breach response plan?*

YesNo

Do you use encryption for data at rest and in transit?*

YesNoPartial

Do you perform regular data backups?*

Yes — OffsiteYes — Onsite OnlyNo

Do you have written contracts / MSAs with all clients?*

YesNoSometimes

Do your contracts include limitation of liability clauses?*

YesNoNot Sure

Do you work with government or defense clients?*

YesNo

Do you provide services outside the US?*

YesNo

Premises & Property

Office arrangement*

Square footage of office

Number of office locations

Estimated value of computer / tech equipment ($)*

Do employees work remotely?*

Yes — All RemoteYes — HybridNo — All In-Office

Do employees use personal devices for work (BYOD)?*

YesNo

Claims History (Past 5 Years)

Have you had any claims or losses in the past 5 years?*

YesNo

If yes, describe each claim (date, type, amount, status)

0/500

Have you ever been cancelled or non-renewed by an insurer?*

YesNo

If yes, explain

0/500

Current Insurance

Current insurance carrier

Current policy expiration date

Current annual premium ($)

Desired effective date for new policy*

Coverage Requested — Select All That Apply

Additional Information

Any additional information you would like us to know

0/500

Technology / Office Business Insurance Quote

Applicant Information

Technology Operations

Premises & Property

Claims History (Past 5 Years)

Current Insurance

Coverage Requested — Select All That Apply

Additional Information