LSJ Insurance now offers online applications for its clients.
Please Download, complete, print and sign the application and fax to us to get a quote.
Surety and Fidelity Bond Applications:
(DMEPOS) Multi Location Medicare Bond
Dishonesty, Fidelity and Forgery
Contract Bond over $100,000 and up to $500,000
Contract Bond Questionnaire (over $500,000)
Personal Insurance Applications:
Boat & Personal Watercraft Insurance
Dwelling & Homeowners Insurance
Motorcycle and Off-Road Vehicle Insurance
Personal Umbrella Insurance (call our office)
Recreational Vehicle Insurance
Commercial Insurance Applications:
Commercial Specialty Insurance (call our office)
Home Business Insurance (call our office)
“Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.”
Please note that submission of this form is a PRICE QUOTE REQUEST ONLY. Filling out and submitting this form DOES NOT bind coverage in any way. The only way coverage can be bound is when an agent of LSJ Insurance Agency has issued the binder or policy and then notified you that it has been issued. IF YOU DO NOT AGREE WITH THIS DISCLAIMER, DO NOT CONTINUE!