Cyber Insurance Application
JAMERSON MCLEAN & COWBELL CYBER
Organization contact information
Name
*
First Name
Last Name
Current Email Address
*
example@example.com
Is this person willing to serve as Cowbell's designated Information Security Contact?
*
Yes
No
Main business phone number
*
Please enter a valid phone number.
Tell us about your business
Legal Business Name
*
What type of business do you operate?
*
Please Select
Government entity
Private entity
Publicly traded entity
Non-profit
Investment fund
Describe your business by industry / type
*
Business Address
*
Street Address
Street Address Line 2
City
*
City
State
*
Please Select
Alabama (AL)
Alaska (AK)
Arizona (AZ)
Arkansas (AR)
California (CA)
Colorado (CO)
Connecticut (CT)
Delaware (DE)
District of Columbia (DC)
Florida (FL)
Georgia (GA)
Hawaii (HI)
Idaho (ID)
Illinois (IL)
Indiana (IN)
Iowa (IA)
Kansas (KS)
Kentucky (KY)
Louisiana (LA)
Maine (ME)
Maryland (MD)
Massachusetts (MA)
Michigan (MI)
Minnesota (MN)
Mississippi (MS)
Missouri (MO)
Montana (MT)
Nebraska (NE)
Nevada (NV)
New Hampshire (NH)
New Jersey (NJ)
New Mexico (NM)
New York (NY)
North Carolina (NC)
North Dakota (ND)
Ohio (OH)
Oklahoma (OK)
Oregon (OR)
Pennsylvania (PA)
Rhode Island (RI)
South Carolina (SC)
South Dakota (SD)
Tennessee (TN)
Texas (TX)
Utah (UT)
Vermont (VT)
Virginia (VA)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)
State
Year Established
*
Please enter year when your business started
Zip Code
*
Zip Code
Projected Revenue
*
Please enter projected 12 month revenue for your business
Prior 12 month Revenue
*
Please enter your prior 12 month revenue for your business
Number of Employees
*
Please enter number of employees at your business
Security Info
Have you ever had any cyber insurance claim(s)?
*
Yes
No
Does your organization encrypt all emails, mobile and computing devices containing sensitive information sent to external parties?
*
Yes
No
Does your organization have sensitive information stored on the cloud?
*
Yes
No
Social Engineering Coverage: Does your organization prevent unauthorized employees from initiating wire transfers?
*
Yes
No
Social Engineering Coverage: Does your organization authenticate funds transfer requests (e.g.by calling a customer to verify the request at a predetermined phone number)?
*
Yes
No
Social Engineering Coverage: Does your organization verify vendor/supplier bank accounts before adding to their accounts payable systems?
*
Yes
No
Submit your application for review
Select your policy aggregate limit
$50,000
$100,000
$250,000
$500,000
$1M
$2M
$3M
Privacy
Terms
Terms and Conditions
*
I attest that the information presented is a complete, true and accurate representation on this business and understand that any fraudulent intent is subject to criminal and civil penalties.
Submit
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