Years in business *
Select New / Startup Less than 1 year 1-2 years 3-5 years 6-10 years 11-20 years 20+ years
Business entity type
Select Sole Proprietorship Partnership LLC Corporation S-Corporation Nonprofit 501(c)(3) Government Entity
Annual gross revenue *
Select Under $500,000 $500,000 - $1 million $1 million - $2.5 million $2.5 million - $5 million $5 million - $10 million $10 million - $25 million $25 million - $50 million $50 million - $100 million $100 million+
Total employees *
Select 1-10 11-25 26-50 51-100 101-250 251-500 501-1,000 1,000+
What sensitive data do you collect, store, or process? (check all that apply) *
Total # of records (PII / sensitive) *
Select Under 1,000 1,000 - 10,000 10,000 - 50,000 50,000 - 100,000 100,000 - 500,000 500,000 - 1 million 1 million - 5 million 5 million+
Do you accept credit cards?
Select No Yes - Third party processor only Yes - We store fx-card data
Annual credit fx-card transactions
Select N/A - Don't accept cards Under $100,000 $100,000 - $500,000 $500,000 - $1 million $1 million - $5 million $5 million+
Are you PCI-DSS compliant?
Select N/A - Don't process cards Yes - Certified compliant In progress No Unknown
Cyber readiness snapshot
0 / 18 Add your controls below
Carriers increasingly require these baseline controls before they'll bind cyber coverage:
MFA
Endpoint detection
Tested backups
Staff training
IT management
Select In-house IT staff Outsourced to MSP/IT provider Both in-house and outsourced Owner/staff managed (no dedicated IT)
Cloud vs on-premise
Select 100% Cloud-based Primarily cloud (some on-premise) Hybrid (mix of both) Primarily on-premise 100% On-premise servers
Security controls in place (check all that apply) *
MFA deployed for
Select Not deployed Email only Remote access only Email + Remote access All systems / applications
Backup frequency
Select Real-time / Continuous Daily Weekly Monthly Irregular / Unknown
Do you allow remote work?
Select No - All on-site Limited remote work Hybrid workforce Fully remote
Use of personal devices (BYOD)?
Select No - Company devices only Limited BYOD with policies Yes - BYOD allowed Yes - No formal BYOD policy
Which regulations apply to your business? (check all that apply)
Any security certifications?
Select None SOC 2 ISO 27001 SOC 2 + ISO 27001 HITRUST Other
Written privacy policy?
Select Yes - Published on website Yes - Internal only In development No
Any cyber incidents in past 5 years? *
Select No incidents Yes - Minor incident(s) Yes - Significant incident(s) Yes - Insurance claim filed
Has cyber coverage been declined?
Select No Yes First time applying
If incidents occurred, please describe
What coverages are you interested in? (check all that apply) *
Preferred contact method
Select Phone Call Email Text Message Video Call Any method is fine
Best time to reach you
Select Morning (8am-12pm) Afternoon (12-5pm) Evening (after 5pm) Anytime
How did you hear about us?
Select Google Search Referral IT Provider / MSP Trade Association LinkedIn Existing Client Other
Additional comments or questions
