ISBA Insurance Program

ISBA Insurance Program
P.O. Box 410679
Kansas City, MO 64141-0679

For Deliveries:
7300 College Blvd., Suite 500
Overland Park, KS 66210

Toll-Free: (800) 679-7154
Fax: (913) 652-3993
E-mail: ISBAinsurance@locktonrisk.com

Complete and send the form below
to request additional information:

Name:
Company:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone:
Fax:
Email:
Best time to contact:
Number of Attorneys:
Professional Liability Expiration Date:
Estimated Insurance Costs:
Have there been any claims?	Yes No
How did you hear about us?
Questions or Comments:

Insurance Program Administered by Lockton Risk Services