Church Insurance
949-421-0222 / 1-800-255-1460

Blackwell Insurance Agency is your Church Insurance Specialist.
Please input the following information for a proposal and hit submit.

We will call you back with a quote within 48 hours.

We have been a church insurance specialist for many years now.
Please call our office for the most comprehensive coverage at the lowest rates.
We can usually provide a proposal in just a few hours.

Ask for: SCOTT BINGHAM
800-255-1460
E-mail: scottb@blackwellins.com

Church Name:   Mailing Address:
Physical Address If Different:   County:
Church Contact Name:   Federal Employers ID#:
Phone / Fax #'s:   E-mail Address:
Website:   Square Feet and Floors of Building #1:
Age of Building #1:   Square Feet and Floors of Building #2:
Age of Building #2:   Approximate Age of all Roofs:
Approximate Distance to Fire Dept:   Weekly Attendance:
Claims in the Past 5 Years:   Current Insurance Carrier:
Current Annual Premium:   Does Your Church Have a School? Yes No
Does Your Church Have a Day Care? Yes No Does the Church Have a Van or Bus? YesNo
Workers Comp Quote?   Pastors Life Ins?

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Blackwell Insurance Agency
23101 Lake Center Dr #130, Lake Forest, CA 92630
949-421-0222 / 1-800-255-1460

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