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All our Website Design Services require a minimum monthly recurring fee of $50.00.  This fee includes all future updates, changes, additions and ongoing site modernization phases.  Therefore, you will never pay any additional fees or hourly rates for all future updates other than our base monthly fee.

Invoicing for all your combined recurring services is performed on a quarterly "calendar based" schedule.  January 1, April 1, July 1 & October 1 of each year.

 NEW ACCOUNT ONLINE ORDER FORM:

Tip: You can use your keyboard's "TAB" key to move through these questions in proper order.


SELECT TO ORDER YOUR WEBSITE
FEATURES AND OPTIONS:

Are you "Trading In" an Agency Website You Currently Have:

I am ordering our Agency's new website & we wish to "Trade-In" our current website and receive a $300.00 credit towards the final purchase price.

What is the address of the site you are "trading in" to receive this credit:
www.

PRICE: $995.00 one time fee.

 I am ordering our Agency's website design & service package from InsuredCo.

PRICE: $1,295.00 one time fee.

Website & Email Hosting, plus Anti-Spam/Virus Filtering:

Website & Email Hosting:
YES!  I want InsuredCo to provide me with Web Site Hosting & Unlimited
E-mail Account Services for my new Website.

PRICE: $14.95 per month.

 NO!  I do not want InsuredCo to provide me with Web Hosting and
E-mail services for my new Website.  I will use or obtain these services elsewhere.
         
Email Anti-Spam/Virus Filtering:

YES! Please ADD Anti-Spam & Virus Filtering to all our Email accounts to be Hosted with InsuredCo.

PRICE: $24.95 per month.

Although we are Not Hosting our Email with InsuredCo, we want to order Anti-Spam & Virus Filtering for all our Email accounts, which are hosted elsewhere.

PRICE: $29.95 per month.

NO!  I am not ordering Email
Anti-Spam/Virus Filtering.		    

Online Quoting Forms Integration:

I want to include InsuredCo's FREE QUOTE FORMS integration in my completed Website.

PRICE: $0.00

 I wish to discuss having my site linked to ANOTHER OPTION for including ONLINE QUOTE INTEGRATION into my completed Website.

PRICE: N/A to this order.

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PLEASE PROVIDE THE FOLLOWING INFORMATION REGARDING YOUR INSURANCE AGENCY:

What is the formal name of your agency?
 
Agency Name:
Year Agency Began:
State Licensing:

Example: KY, TN, VA, GA, etc..
Agency Colors:

Example: Dark Blue & White

Please enter the Full Name of primary contact who will be
responsible for answering questions regarding this account:

Your Full Name:
(First Name - MI - Last Name)

If you have an agency slogan, please enter it here:

Slogan:

What is your Agency's MAILING Address?

Address:
City:
State:

Zip Code:

What is your agency physical LOCATION address?

Address:
City:
State:

Zip Code:

Agency telecommunications information:
 
Agency Phone:
(area-telephone)
Toll Free:
(prefix-telephone)
Agency Fax:
(area-telephone)
Agency E-mail Address:

SETTING UP YOUR E-MAIL ADDRESSES:

Please enter a FIRST NAME + LAST NAME list of all
PRODUCERS, CSR's or PRIMARY PERSONS who
work in your agency:


Example: Bill Rodgers, Lisa Hall, Stacy Hoffman, Sam Sample, etc., etc.

How do you want each E-mail Address to be Named:
If a person within your agency had the name of "Sam Sample", please select the E-mail address name configuration you would like to use...

Example - Sam Sample's E-mail Address Would Be:

sams@youragency.com (first name, last name initial)
sam.sample@youragency.com (first name.last name)
 sam@youragency.com (first name only)
 ssample@youragency.com (first name initial, last name)
 sample@youragency.com (last name only)

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Please enter a list of all INSURANCE COMPANIES 
you currently represent:


Example: Progressive, AIG, Safeco, Zurich, etc., etc.

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DO YOU NEED A WEBSITE ADDRESS, OR DO YOU ALREADY HAVE ONE...

If you currently DO NOT have a Website address,
please tell us what you would like it to be:

www.
 

If your agency already has a Website,
what is your Internet address?

www.
You will be able to keep your present address!

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Please select the types of policy lines you currently offer:

Automobile:
Homeowners:
Business/Commercial:
Life:
Liability Umbrella:
Recreational Vehicles:
Commercial Vehicles:
Water Craft - Boats:
Individual Medical / Health:
Group Medical / Health:
Long Term Care:
Workers Comp:

 
List other types or specialty lines if applicable:

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Do you plan on having photos of yourself and/or staff,
office, etc., in your site?   

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Payment Options:
Note: You are not billed until your site is completed and available online at Your Website Address.

Please select how you wish to pay for your InsuredCo account:

Website Design & Setup Payment Options:
Using Visa/MasterCard/Amex (card info not required to complete order)
 Invoice My Agency at our Mailing Address  (listed near the top of this form)

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Comments or Additional Requests:

Were You Referred To InsuredCo through a third party?
Please enter the Persons Name, Agency Name, Website, or
Organization who referred you to InsuredCo? (if applicable)

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Acceptance Agreement

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Security Confirmation Code:

Enter the Security Code as Shown:

You will not be billed until such time as your site is completed and available online.
At that time we will contact you to verify all charges before billing your account.


 

 

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Website Design Services  |  Website Trade-In Program  |  Ongoing Site Services
Quoting & Policy Maintenance Forms  |  Website Hosting & Email Services  |  Anti-Spam & Email Virus Filtering
Free Webmail Upgrade  |  Free Automated Email List Mngmnt  |  Factoring Your Investment

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Submit Your Order Online


 Accepting Visa, MasterCard and American Express for all design & setup fees.

InsuredCo.com
Tel: (615) 799-5956  |  Fax: (888) 716-1472
Email: info@insuredco.com
 
Copyright © 1998-2008 InsuredCo.com - All rights reserved.

TEL: 615.799.5956