Do you have an Insurance Submission that may fit our Program?

There are several ways you can submit a risk—choose the one that works best for you.

ONLINE FORM

Fill out the form below to submit a risk.

Submit A Risk

  • Agent / Broker Contact Information

    Please provide your contact information and some general information about the risk.
  • If you know the actual or desired effective date, please enter it or select it using the calendar.
    MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

PHONE

Contact us at 800.622.8272 and speak directly to one of our Underwriters.

Send your contact information and the website address of your risk by e-mail to siegel@siegelagency.com. Our underwriting department will contact you.

You may also submit a brochure, website address, or application to ISA by mail or fax:

Irwin Siegel Agency
P.O. Box 309
25 Lake Louise Marie Road
Rock Hill, NY 12775-0309

Fax: 845.796.3661