| * Required fields |
| Name *
|
|
| E-mail Address *
|
|
| Address * |
|
| City, Zip Code * |
|
| Business Phone Number |
|
| Please provide us with the number of years you have been in the childcare business |
|
| If registered are you a catagory: * |
A
B
C
Not an Iowa Registered Provider
|
| Please list your current insurance carrier: |
|
| Maximum number of children you watch during each day: |
|
| Number of children your Iowa Registration allows you to care for |
|
| Preferred liability limit: |
|
| Type of Childcare Facility * |
|
| Important liability coverage I would like included in proposal: |
Abuse and Molestation
Animal Liability
On or off premises water activities
Abduction liability coverage
All of the above
|
| Our business will need coverage for our building and/or business property |
|
| How did you find our website? * |
|
| In addition to childcare liability I will be requesting coverage for: |
Business Auto
Commercial Umbrella
Both
None
We should talk about this
|
| How may we contact you? * |
Telephone
Email
Either Telephone or Email
|
| If insured in the past, have you personally or your business ever been cancelled due to claims? |
|
| You can save an additional 10% on your home and auto insurance coverages if your daycare insurance is placed with us.... would you like a quote for your auto and home insurance in the event we write your daycare insurance coverage? |
|
| Please provide us any additional details that you deem pertinent to your business |
|
| How did you find www.IowaDayCareInsurance.com? |
Newspaper Advertisement
Mailing Advertisement
Internet Search
Referred from another daycare provider
Hasn't everyone heard of www.IowaDayCareInsurance.com?
|
| This coverage is for Iowa Daycare Providers only.... |
Yes, that is obvious.
I am not from Iowa, but enjoy completing internet forms for absolutely no reason.
|
