Employee Dishonesty

To receive a quote, please fill out the form below.......
Company Name:
Contact Person:
City:       State:      Zipcode: 
Phone Number:           E-Mail Address: 
Business Type:
    What does your business do? 

Have you sustained any employee dishonesty losses in the last 6 years?  Yes  /  No
Amount of coverage  requested: 
Classification of Business
Professional & Business offices such as accountants, architects, physicians, dentists, insurance agents, and attorneys.   (Officers are not covered under this bond, unless the insured is a corporation, and the officers are in the regular service of the insured and compensated by salary, wage, etc).
Exact # of Employees (both full & parttime): 
Exact # of Officers....................................: 
     Are officers to be covered?  Yes /  No
Non-Profit Social Organizations (OFFICERS ONLY) Exact # of Officers: 
Businesses with more exposure such as cafes, gas stations, retail stores, businesses with salespeople, non-profit social organizations (officers & employees: volunteers are not covered unless endorsed by the insurance company) and courier services (except those handling cash & negotiable instruments ). Exact # of Employees (both full & parttime): 
Exact # of Owners/Officers........................: 
     Are officers to be covered?  Yes /  No
For dishonesty limits $ 50,000 and Over, please complete the following:
Will Countersignature  of checks be required?  Yes  /  No
    If "Yes", by whom: 
How often will a complete audit be made?          Last Audit was made:  (date)
Who made the last audit:  CPA /  Independent Accountant /  Employee of Insured
Are bank accounts reconciled by someone not authorized to deposit or withdraw from them?  Yes  /  No

M c G R A T H   I N S U R A N C E   G R O U P

I          N          S          U          R          A          N          C          E

4170 William Penn Highway     Murrysville, PA. 15668
(724) 327-8474        (FAX) 327-7911
Toll Free: 1-800-977-2999    (FAX) 1-888-800-0034