Claim this Month's Bonus

 
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Fill out and submit this form for everynew policy you write* to receive an Amazon or Walmart Gift Card.

*Here is the fine print:

1: Your effective date must be within the month of the promotion. If you write your policy the last day of the month, be sure to fill out this form to claim the reward.

2: Summer's promotion is valid for any new policy written. It can be for anyproduct, regardless of product line. We just want you to write a new policy this month. :)

3. This promotion is per licensed agent.

4. Please keep in mind any agent receiving $600 or more in rewards will receive a 1099. (Don't blame us, it's Uncle Sam's rule)

Policy: Insured's Name *
Policy: Insured's Name
Policy: Product Type *
Your Name (Licensed Agents Only) *
Your Name (Licensed Agents Only)
Your Mailing Address *
Your Mailing Address
Phone Number *
Phone Number

The fun doesn't stop here.  This promotion runs from June thru August!  If you have any questions, give us a call at 1-800-334-4311 today.