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Quick Quote The staff of Premier Physicians Insurance Company can prepare a preliminary Quick Quote for you within 24 hours. Simply fill out the information below and let us show you how Premier Physicians Insurance Company can work for you. The rates provided through Quick Quote are based on the information provided and are not considered final. Final rates can only be generated by completing a Full Application (PDF). Physicians Name Practice Location Type of Practice Contact Person Phone Fax Email Medical Specialty Surgery Yes No If Yes: Major Minor Current Carrier Retro Date Effective Date Current Limits Current Premium Additional Comments/Notes

The description herein is for informational purposes only. It is not an insurance policy or part of the insurance contract, stock purchase agreement, or private placement memorandum. It does not include all terms and conditions of the coverage described. Please refer to the actual policy, stock purchase agreement, and private placement memorandum for complete details of coverage, endorsements, and exclusions. Coverage available in Nevada, California, Arizona, Oregon, and Utah. Coverage subject to underwriting approval. Copyright © 2007-2008 Premier Physicians Insurance Company All Rights Reserved, Worldwide Phone: (866) 371-7742 E-mail: info@ppicdocs.com