for your convenience

applications and forms

Please complete and return the appropriate form.

You can email to your Highland Risk contact or, if this is your first time, you can email to quotes@highlandrisk.com. Our general fax number is 847.574.7611.

Nursing Home Application	ALF Application	Broker Agreement	Surplus Line Certificate	TRIA Terrorist Form

Submission requirements:

To receive a quote, please provide the following data:

• Current financials
• 5 year loss-runs
• Completed application