Cyber Liability Quote Form

Cyber Liability Quote Form

Home Commercial Cyber Liability Cyber Liability Quote Form

Company Name*
Year of Incorporation*
Entity Type*
If "Other" please input Entity Type
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Website
Number of Employees*
Projected Annual Revenue*
Description of Operations*
Percentage of Online Revenue*
Name*
First Last
Email*
Phone*
Type of Data Stored*
- Names and Addresses
- Credit Card Information/Bank Account Numbers
- Social Security Numbers
- Medical Records
- Other Financial Information
Number of Records the Company Handles or Stores*
Are antivirus and firewalls in place?*
Does the Company use encryption for sensitive information?*
Does the Company use encryption of mobile computing devices?*
Does the Company make use of critical software patching procedures?*
Does the Company have critical data backup and recovery procedures?*
Does the Company have Formal Cyber Incident Response Plan?*
Does the Company accept payment card transactions?*
If "YES," is the Company PCI compliant?
Does the Company deal with protected information as defined by HIPAA?*
If "YES," is the Company compliant with HIPPA and the HITECH Act?
Has the Company obtained legal review of its use of trademarks, including domain names?*

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Cyber Liability Quote Form

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Cyber Liability Quote Form

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