1 1 Policy Options
2 2 Application Form
3 3 Additional Insureds
4 4 Payment, Review & Submit

Capital Premium Testing Policy

Sorry, we don't have availability to purchase it online, but we are working on it! In the meantime, please submit quote for underwriting and we’ll reach out with any remaining questions!
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This policy will go into force on the start date and stay in force for 12 months.

Payments for this policy will stay in effect until cancelled.

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Your application will be submitted for underwriting.
Your application cannot be completed online.
Your application will be submitted for underwriting.
Your application will be submitted for underwriting.
Your application will be submitted for underwriting.
Your application will be submitted for underwriting.
Your application will be submitted for underwriting.
Your application will be submitted for underwriting.
Your application will be submitted for underwriting.
Your application will be submitted for underwriting.
Your application will be submitted for underwriting.
Your application will be submitted for underwriting.

Physical Address

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Name can be between 2 and 70 characters long and can contain letters, hyphens, commas, dots, apostrophes and spaces
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
This field is required
Name can be between 2 and 70 characters long and can contain letters, hyphens, commas, dots, apostrophes and spaces
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
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WE CANNOT ACCEPT A PO BOX AS A PHYSICAL ADDRESS. KINDLY ENTER A PHYSICAL ADDRESS FOR YOUR BUSINESS.
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
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You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
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You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
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Please click here to be directed to an application that is specifically for those whose business is in .
Quote only for this state.

Due to the natural disaster in your area, We are unable to provide a policy to purchase for your selected effective date, please go back to this option and select a date that is available to you. We will begin selling same day policies again in your state when the memorandum has been lifted.

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Invalid physical ZIP code
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
Your state and zip code are invalid. Please edit your address. Suggested state:

Mailing address

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You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
This field is required
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
This field is required
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
This field is required
Please click here to be directed to an application that is specifically for those whose business is in .
Quote only for this state.

Due to the natural disaster in your area, We are unable to provide a policy to purchase for your selected effective date, please go back to this option and select a date that is available to you. We will begin selling same day policies again in your state when the memorandum has been lifted.

This field is required
Invalid ZIP code
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.

Business information

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Business name - Only letters(A-Z), numbers(0-9), &(ampersand), -(hyphen), '(apostrophe), .(dot), comma, ()brackets, spaces, ‘ ’(curly apostrophes), /(slash), :(colon), ;(semicolon) are allowed.
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
Please provide your full name under mailing address.
A business you own and operate, not a business that employs you.
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You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
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Invalid phone
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
This field is required
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.

Primary Business Activity

Secondary Business Activities

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When you add a person†, event, or organization to your policy as an additional insured, they receive protection if they are named in a suit due to a covered business-related loss/claim because of your actions or operations.

† Additional insured status cannot be granted to a friend or co-worker as an extension of your policy. Each individual must purchase their own policy to obtain liability coverage.

† A written contract, such as a venue, studio rental, or employment contract is required to add another party as additional insured.

Payment information

Initial payment:

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Down Payment(due today):
APR Interest Total

Quote Agreement

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Credit card information

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Invalid credit card number
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
This field requires 13 to 16 digits. Use only numbers. No spaces or dashes.
Please enter your credit card and bank information. Your credit card will be used for the down payment and your bank information will be used for the Capital Premium finance agreement monthly draft. If you have questions about alternative payment methods for the capital monthly draft please contact Capital Premium.
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Use the up and down arrow keys to select your card's expiration month. Each option is labeled with the full month name.
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Use the up and down arrow keys to select your card's expiration year.
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Invalid cvv
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
This is a 3-digit number on the back of Visa, MasterCard, and Discover cards, or a 4-digit number on the front of American Express cards.
This field is required
Invalid ZIP code
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
Enter your 5-digit ZIP code. Only numeric input is accepted.

This feature will create a customer payment profile for your billing information to allow easy checkout during future policy coverage extensions or updates. Credit card information is not stored within our system. All billing information is processed through authorize.net

Your credit card expires before auto renew date ({[{ policyEndDate.format(dateViewFormat) }]}). In order to proceed, please use other credit card.

Your policy is set up to automatically renew on {[{ policyEndDate.format(dateViewFormat) }]}.

More Details
This field is required
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
This field is required
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
This field is required
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.

Credit card information

This field is required
Invalid credit card number
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
This field requires 13 to 16 digits. Use only numbers. No spaces or dashes.
Please enter your credit card and bank information. Your credit card will be used for the down payment and your bank information will be used for the Capital Premium finance agreement monthly draft. If you have questions about alternative payment methods for the capital monthly draft please contact Capital Premium.
This field is required
Use the up and down arrow keys to select your card's expiration month. Each option is labeled with the full month name.
This field is required
Use the up and down arrow keys to select your card's expiration year.
This field is required
Invalid cvv
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
This is a 3-digit number on the back of Visa, MasterCard, and Discover cards, or a 4-digit number on the front of American Express cards.
This field is required
Invalid ZIP code
You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
Enter your 5-digit ZIP code. Only numeric input is accepted.

This feature will create a customer payment profile for your billing information to allow easy checkout during future policy coverage extensions or updates. Credit card information is not stored within our system. All billing information is processed through authorize.net

Your credit card expires before auto renew date ({[{ policyEndDate.format(dateViewFormat) }]}). In order to proceed, please use other credit card.

Your policy is set up to automatically renew on {[{ policyEndDate.format(dateViewFormat) }]}.

More Details


Order summary

Policy Holder Edit

, ,
Email:
Email:
Mobile number:

Mailing Address is the Same as the Physical Address
Mailing Address:
, ,

Payment Information Edit

Payment Method:

Enrolled in EZ-Renew You are not enrolled in EZ-Renew
Edit Enroll
Your policy is set up to automatically renew on . With the EZ-Renew feature your insurance coverage will be continuous without you worrying about having a lapse in your insurance policy coverage.

Capital Premium Testing Policy

Payment Breakdown

Policy start date: - Policy end date: Edit

If changes are needed, please reach out to your agent.
Edit

Policy Holder Business Information

Edit
Business Type
name
DBA
Mobile number
Website
Business Activities
Business Activities Description
Product Description

Additional Insureds

Edit
Unlimited Additional Insureds
Additional Insureds
{[{ ai.name }]}

Employees

Edit
{[{ employee.firstName }]} {[{ employee.lastName }]}

Independent Contractors

Edit
{[{ contractor.firstName }]} {[{ contractor.lastName }]}

Your policy will be issued and your documents available immediately after clicking the "Purchase Policy" button below. Your policy application may be subject to review by our underwriting team to verify that the business operation, product, and/or service meet the eligibility guidelines established for the program. In the event we need further clarification to determine eligibility, we will contact you via email at the email address used to establish your account. If an account is found to be ineligible during the underwriting period, the policy will be subject to immediate cancellation and a full refund will be issued. After the underwriting period, the premium is 100% earned and no refunds will be given.

Your agent will be contacting you soon. There is a pending document to be submitted.
{[{ couponResult.text }]}
Discount applies to Additional Insureds only!
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You must own the business to purchase the insurance policy. We identify that this business name is disallowed from purchase.
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You need a policy that's as unique as your business. After your quote is submitted, one of our sales agents will contact you within 48 hours to complete your quote.

We noted you have made changes to the application you previously submitted. After clicking SUBMIT FOR QUOTE, your application will be sent again for our team to review.

Please click here to be directed to an application that is specifically for those whose business is in .
Quote only for this state.
Capital Premium Testing Policy

Policy Endorsements

Additional insureds

Coverage for Employees

Coverage for Independent Contractors

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This will be your recurring monthly payment after today. We will automatically charge your card each month.
$
monthly
DUE TODAY: (downpayment)

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