Online request for Cyber Insurance Small to medium-sized firms program Current Business information Contact Information Company name Address Address (optional) City/Town (optional) Postal Code (optional) Description of your business activities (optional) Website address (optional) Founding date (optional) Number of employees (optional) Help us learn more about your business Are your business's gross revenues $50,000,000 or less? Yes No Is your business part of the following industry sectors: Financial, recovery or financial advice business Yes No Technology or media company Yes No Law firm, a franchise business Yes No Municipality Yes No Manufacturing company, distribution company or wholesaler Yes No Is it involved in directly providing goods or services to the cannabis industry? Yes No Is it directly involved in the use or supply of cryptocurrency? Yes No Has she been the victim of a cyber incident resulting in a financial loss of more than $10,000 in the last three (3) years? Yes No Has it been the subject of any legal action filed or threatened or the subject of regulatory action filed in the last five (5) years as a direct result of a cyber incident? Yes No Want to get service directly? Skip the form and call 1 855 587-7437
