HOME, CONDO UNIT, APARTMENT QUOTE

Thank you for your interest in Archer Insurance. Who might you be? *

I am a customer
I am a realtor on behalf of a customer
I am a Non-Realtor professional on behalf of a customer

Your Email *

Customer Email *

Customer Name *

First

Last

Customer Date of Birth *

Please use XX/XX/XX format

Select Your Real Estate Office *

Which KW office do you work out of? *

Tell us which KW office. *

Describe your relationship to the client. *

Are you a loan officer, attorney, accountant, car dealership, or from some other industry?

Your Name *

First

Last

Your Phone *

Customer Phone *

Help us to better understand what the property insurance needs are *

Purchasing property
Quote for existing property
Listing/Selling property

Closing Date? *

Approximate date is fine if unknown.

Customer's Current Residential Address?

Address Line 1

Address Line 2

City

State

Zip Code

Property (to be insured) Address *

Address Line 1

Address Line 2

City

State

Zip Code

Occupancy *

Owner
Tenant
Will be vacant for a bit...

Any rehab being planned at the property after closing? *

Yes
No

Describe the work being planned. *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

# of Families *

Is there insurance currently in place? *

Upload Policy *If you'd like

Providing a copy of the existing insurance will simply this process for you!

How did you hear about Archer Insurance? *

What real estate office are you working with? *

What is your Keller Williams agent name? *

Which KW office do they work out of? *

Type the name of the KW office. *

Tell us their name so we can thank them! *

Let us know of any special comments or concerns you may have.

Checking this box indicates that you have read this. *

Archer Insurance is an independent insurance broker licensed by the Commonwealth of Massachusetts. Archer Insurance, Keller Williams Realty Beverly, Keller Williams Realty Eastern Middlesex and Keller Williams Realty Greater Newburyport are independent entities. Each are party to agreements pursuant to which commissions on insurance customer accounts are shared. These agreements do not increase or in any other way affect premiums should you elect to place your insurance coverage thru Archer Insurance.

Sign here demonstrating that you understand the Archer/KW relationship. *