Your first step saves a request for follow-up. The detailed underwriting questions come next. Text permission is optional.
Start with how to reach you. Four quick details and we can help, even if you finish the rest later.
General contractor New builds, remodels & project management Civil contractor Excavation, utilities, grading & infrastructure Roofing Residential & commercial crews Home services HVAC, plumbing, electrical & more Moving company Local moves, fleets & storage Tech & marketing Software, agencies & lead generation Another business Tell us a little about your work
First name * Last name * Email * Phone * Preferred contact method *Email Phone call How did you hear about PrimeRisk? *Select one Google search / Maps AI assistant / LLM Referral Social media Other search engine Website / blog Existing client / returning customer Email / newsletter Event / networking Directory / listing Other I don’t remember Which AI assistant? *Select one ChatGPT Claude Gemini Perplexity Microsoft Copilot Google AI Overviews / AI Mode Grok Meta AI Other AI assistant I don’t remember Other AI assistant name * Which site, platform or person? Optional
Select Save & continue to send these details to PrimeRisk and authorize follow-up about this request. Then complete the detailed questions. No coverage is bound.
Tell us about your work. Your contact details are saved. Now tell us about your business and work so we can review your insurance needs. Estimates and “Not sure” are fine.
Business name * Business website Optional Primary business state *Select a state Arizona California Colorado Nevada New Mexico Texas Utah Another state ZIP code * State name *
Availability depends on your state and business operations. We’ll confirm what we can help with.
What would you like to discuss? * Select all that apply.
Current insurance *Select Insured, exploring options New business / not insured Need additional coverage When do you need coverage? *Select As soon as possible Within 30 days Within 60–90 days Planning ahead
Describe your products or services * Team size *Select a range Owner only 1–5 employees 6–20 employees 21–50 employees 51+ employees Estimated annual revenue Optional Select a range Pre-revenue / new business Under $250,000 $250,000–$1 million $1 million–$5 million $5 million–$10 million Over $10 million Prefer to discuss
Your roofing work Primary work *Select Residential Commercial Both Do you use subcontractors? *Select Yes No Planning to
Your trade Primary trade *Select HVAC Plumbing Electrical Remodeling Landscaping Cleaning Another trade / multiple trades
Your technology or marketing business Primary service *Select Marketing agency Lead generation company Marketing automation / CRM services Software / SaaS IT services / MSP Technology consulting Cybersecurity services AI products / services Other technology services Do clients require insurance? *Select Yes No Not sure
A few cyber questions “Not sure” is a useful answer. These questions help guide the follow-up.
Multi-factor authentication in use?Select Yes Partially No Not sure Separate or protected backups?Select Yes No Not sure
Anything else we should know? Optional
Review your request. Review your request. You can go back to edit underwriting answers. Use the notes field to flag corrections to your saved contact details.
Please do not submit Social Security numbers, payment card details, medical information, or passwords. Your request will be securely delivered to PrimeRisk. We’ll email you a confirmation and save your contact and company details in our CRM. It does not bind coverage, guarantee a quote or change your current insurance.
