New business request form

Guidelines

Use this form only if you do not have an active vendor relationship with Markel Claims.
Requests are reviewed quarterly.
Claims Vendor Management Office will contact you for additional information if needed.
Markel retains this information for vendor profiles.
All fields are required unless otherwise noted.
If a field is not applicable please use N/A.
If you have issues submitting this form, please contact claimsvmo@markel.com.

Fields with an asterisk (*) are required.

Type of request:

Name of Markel contact:

Name (firm or company):

TIN:

Address line 1:

Address line 2: (optional)

City:

State:

Zip/Postal code:

Contact name:

Contact title:

Contact e-mail:

Contact phone:

Company web site:

National Local

All fields in this category are optional

Please expand on any "expert" ratings noted above:

What line(s) of business hold(s) the majority percentage of work for your firm/company?

Do you currently use the Bottomline Legal Exchange/Allegient bill review/invoicing system? Yes No

Please give a brief overview of the services you can provide:

Any additional information you would like to provide: (optional):