Affiliate Agent Quote Submission

SUBMIT A QUOTE

Please fill out this form to let us know that the lead came from YOU.
We want you to get credit for any leads you generate.
Failure to do this may result in your lead being classified as a house account and you will not get paid!!

Type(s) of policy/policies (Check all that apply):

Do you want to gather information from the prospect for us to run quotes?

To submit your Home/Auto/Umbrella Quote Information, click here:

Do you want to present the proposal and close by yourself?

Upload quote sheets or photos (accepted file types: jpg, jpeg, png, gif, doc, docx, pdf only. Max 8 files@ 4MB each)

Do you have any notes for your Lead Manager?

*Note: NO HOME OR DWELLING POLICIES WILL BE ISSUED UNTIL PHOTOS ARE UPLOADED OR SUBMITTED TO PHOTOS@AGENCYASSOCIATES.NET (include name of applicant and address of dwelling)

*ALL HOMES MUST BE IN GOOD CONDITION OR HAVE CONDITION ISSUES NOTATED

*PERCENTAGES ARE FROM EARNED POLICY COMMISSIONS