*Fields with an asterisk are required. (Information submitted will remain confidential.)
First Name *
Last Name *
Address Street 1 *
Address Street 2
Association referred by? *
American Foundry Society
Association for Contract Packagers & Manufacturers
Cold Pressure Council
Graphic Media Alliance
Number of Employees *
Estimated Annual Revenue - next 12 months *
Gross Profit / Net Revenue expected over next 12 months *
Within the last 3 years has the company suffered any cyber incidents resulting in a claim in excess of $25,000? *
(If Yes) please explain the cyber incidents and/or claims.
Is the company aware of any circumstances that could give rise to a claim under this insurance policy? *
(If Yes) please explain the circumstances and/or potential claims.
Does the company implement encryption on laptop computers, desktop computers, and other portable media devices? *
Does the company collect, process, store, transmit, or have access to any Payment Card Information (PCI), Personally Identiﬁable Information (PII), or Protected Health Information (PHI) other than employees of the company? *
(If Yes) What is the estimated annual volume of payment card transactions (credit cards, debit cards, etc.)?
(if Yes) How many PII or PHI records does the company collect, process, store, transmit, or have access to?
Does the company maintain at least weekly backups of all sensitive or otherwise critical data and all critical business systems ofﬂine or on a separate network? *
Does the company require a secondary means of communication to validate the authenticity of funds transfers(ACH, wire, etc.) requests before processing a request in excess of $25,000? *
Within the last 3 years has the company been subject to any complaints concerning the content of its website, advertising materials, social media, or other publications? *
Does the company enforce procedures to remove content (including third party content) that may infringe or violate any intellectual property or privacy right? *
Do you enforce Multi-factor Authentication (MFA) for Email? *
Do you enforce Multi-factor Authentication (MFA) for Virtual Private Network (VPN), Remote Desktop Protocol (RDP), RDWeb, RD Gateway, or other remote access? *
Do you enforce Multi-factor Authentication (MFA) for Network/cloud administration or other privileged user accounts? *
On Administrative Accounts and All Cloud Services Where Supported