Real Estate Agent Homeowners Insurance Referral Program

TheIndependentInsuranceAgency.com

We've Made Shopping For Homeowners Insurance Coverage Fast, Easy, and Available Online

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It’s Fast, Easy , And Simple To Earn $ 100’s In Extra Monthly Income - Just Scroll Down To Complete Short Online Referral Form.

                            Real Estate Agent's

                                        Homeowners Insurance

                                         Referral Fee Program

                            Get Quick Insurance Quotes With No Obligation What So Ever

Earn $ 10.OO For Each Online Homeowners Insurance Referral Form You Fully Complete Within 48 Hours Of Your Customer Signing A Purchase Agreement.

If Your Customer Buys Their Homeowners Insurance Coverage Through Us We Will Pay You An Additional $ 40.00 Referral Fee.

Here’s How Our Online HomeOwners Quote Request Works

v     You or Your Customer may complete a short online homeowner’s quote request.

v     Click submit button at bottom of our quote request form.

v     Within 24 hour you and your customer will receive a quote from several leading insurance companies we represent.

v     Please refer any customers with questions regarding coverage, rates, or carriers offered to our office as one of our Certified Insurance Counselors will gladly assist them.

We Work Closely With Realtors

To Assure Their Customers Closing Goes Smoothly

After your new homeowner selects which quote best meets their insurance needs & budget we will contact them by telephone to confirm their online order. Once your customer confirms their order we will issue a coverage binder and instruct our underwriting carrier to prepare a copy of the policy to forward to the designated title company prior to the expected closing date, along with an invoice for the initial annual premium.

Coverage We Offer

We offer some of the most comprehensive & competitive homeowner’s policy forms available in the Texas insurance market.

Plans marked with this logo are selected by our agency as 5-StarValue’s. These plans offer an excellent combination of plan Benefits, Policy Features, Insurance Company Stability, Premium Ranking and Overall Premium-to-Benefit Value.

See Our Web Site For More Details.

Please fill out as much information as possible.

If you have any questions regarding this form please contact us.

Homeowners Insurance Referral Form - (Texas Residents Only!)

(* Indicates a required field)

All information provided will be regarded as strictly confidential, and will be used only to secure an accurate quotation for insurance coverage.

Realtor's Contact

Information

Homeowner's Contact Information

Real Estate Agents Name

Real Estate Agency Name

Homeowners Name

Email Address :

(For Our Agency Staff Use Only In Providing Requested Insurance Quotes)

Fax #

Please Send A Courtesy Copy Of The Quote Your Insurance Agency Provides To My Customer By : Email Fax Both

No Copy Requested

( Please refer any customers who have questions regarding quoted coverage , rates, or carriers to our office so that we may have one of our licensed insurance agents/counselors provide such assistance )

Contact Phone Numbers:

Day :

Evening :

Cell :

Email Address :

(For Our Agency Staff Use Only In Providing Requested Insurance Quotes)

Fax #

Send Quote By : Email Fax Both

Contact Phone Numbers:

Day :

Evening :

Cell :

Sold Property Information:

Physical Address Of Sold Property : Address: City: State: Zip: County :
Date Property Sold: (Date Purchase Agreement Executed)		Expected Closing Date : (Date Listed On Purchase Agreement)
Type of Dwelling :		Amount Of Insurance Required To Cover Purchase Price Of Property $
Designated Title Company:		Title Company Contact Person Phone Number:

General Rate Calculation Information Needed To Provide A Homeowners Insurance Quote:

Many pre-selected (Default ) answers have been selected by us to aid you in completion of this form; please make any necessary corrections.

Please review each check box below to assure that each question is correctly answered; then change the checked box to the most appropriately response that applies to your request for a rate quote. Any incorrect information obtained may void the quoted rate or coverage offer .

*Construction:		*Roof:		*Roof Age:		*Square. Footage:
*Year Built:		*Stories:		*Garage:		*# of Car Stalls:
*Occupancy:		*Pool:		*Fenced Pool :		*Trampoline:
*Pets:		(Pets) Breed:		*Alarms:		*Monitored:
*Fire Hydrant Feet To	0-100 101-500 501-1000 1000+	*Fire Station	Miles Within 5 5 -10 10+	*Within City Limits	Yes No	*Primary Residence	Yes No
*Foundation		*Rental Property	Yes No	*Community Entrance Gated or Guarded	Yes No	Sprinkler System	Yes No
*Under Construction	Yes No	*Live Stock	Yes No	*Strom Shutters	Yes No	*Mortgagee	Yes No
*Owner Occupied	Yes No	*Maintenance		*Air Conditioning Ducts		*Farm Home	Yes No
*Fire Place	Yes N	*Wood Burning Stove	Yes N	*Central Air Conditioning Heating	Yes	*Dead Bolt Smoke Alarm Extinguishers	Yes No
Any losses incurred in the last 5 years to the insured's home or personal possessions at this or another location? Yes No If "Yes" Please Provide Details:
Has property insurance been cancelled, declined or non-renewed in the last 5 years? Yes No If "Yes" Please indicate reason property insurance was cancelled, declined or non-renewed?
Is the dwelling to be insured expected to be unoccupied by an owner or tenant for more than 8 consecutive weeks per year ? Yes No

If the home is over 10 years old, please indicate the year updates were completed:

Electrical	Roof	Plumbing	Heating

Comments/Remarks:

Submission of this quote request form to our Agency does not constitute a binding confirmation of new or revised insurance coverage.

To confirm binding or current policy revisions you must receive a written confirmation for any new or change in coverage from our agency staff.