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Real Estate Professionals Errors & Omissions Insurance Estimate


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Broker Information
First Name
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Last Name
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Street
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City
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State
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ZIP / Postal Code
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Primary Phone Number
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E-Mail Address
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Are you an insurance agency?
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How did you hear about us?
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Firm Information
Date broker licensed as a broker
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/ /
Date broker licensed as an agent
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Date firm established
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Average value of properties sold
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Have any licensees of the firm had their license cancelled or revoked in the last 3 years?
Required

Do you currently have E&O Insurance?
Required

Is the firm independently owned and not controlled, affiliated with, or owned by another entity?
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Are you a franchise?
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Do you always offer home warranty programs?
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In what percentage of transactions do you represent both buyer and seller?
Required
Has the firm's name ever changed?
Required

Are you involved in mortgage banking, development, or construction?
Required

Do you perform services to REITS or property syndications?
Required

Does any one client represent more than 25% of the firm's annual commission?
Required

What percentage of your revenues is from REOs?
Required
Number of licensed agents: (include owners and managers)
Total Number of Agents
Required
Agents earning $20,001 or more in commission
Required
Agents earning $20,000 or less in commission
Required
No income (these have no commission income)
Required
Number of agents with professional designations
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Claim Information
Any claims in the last 5 years?
Required

Percentage of Commissions (Must total 100%)
Residential
Real Estate
Required
Raw Land
Required
Appraisals
Required
Property Management
Required
Owned Property
Required
Other
Farm or Ranch (Only include income producing)
Required
Auctioneering (Both residential and commercial)
Required
Mortgage Brokerage
Required
If a new firm, project 12-month gross commission. Gross commission for the last 12 months
Optional
Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

© Aegis Alliance Insurance Agency, All Rights Reserved | 844-692-3447 | Home Office: 13804 Hull Street Road, Midlothian, Virginia 23112