Application for Real Estate E&O Insurance

CRES Express Program Application. Please provide your contact information below & certify the qualifications at the bottom to continue with policy purchase.

Liability Limits and Pricing (includes $75 ClaimPrevent Legal Services and $75 Membership fees)

Liability Limits	Base Pricing Per Claim
Per Incident / Annual Limit	$1,000	$2,500
$100,000 / $300,000	$644.00	$530.00
$250,000 / $250,000	$655.00	$538.00
$500,000 / $500,000	$670.00	$550.00
$500,000 / $1,000,000	$733.00	$598.00
$1,000,000 / $1,000,000	$800.00	$650.00
Additional Desired Coverages

Desired Limits

Desired Retention

Liability Limits Total:

Do you want any of the following coverages included? (if so select desired coverages)

Property Management

Please provide Mandatory Value

Property Management Pricing:

Appraisal

Please provide Mandatory Value

Appraisal Pricing:

Mortgage Brokering

Please provide Mandatory Value

Mortgage Brokering Pricing:

Appraisal License:

Total Amount Due*:

New Customer

Customer Type Corporate Individual

Relationship Type

Relationship Name

Party Status

Customer Details

Business Name

Please provide Business Name

DBA

Office Level

Office Type

Phone No.

Website

Please provide Email

Customer Category

County

Address

Please provide Address

Address 2

City

Please provide City

State

Please provide State

Zip

Please provide Zip

Country

Identification Type

Unique Id Number

Date Issued

Date of Expiry

Nationality

Doing Business As

Date of Birth

Authority 2

Customer Details

First Name

Please provide First Name

Middle Name

Last Name

Please provide Last Name.

Nick Name

DBA

Office Type

Please provide Email

Phone No.

Please provide Phone Number

Work Phone

Customer Category

County

Address

Please provide address

Address 2

City

Please provide city

Country

State

Please provide state

Zip

Please provide Zip

Contact Preference

Existing Contact Person?

Please provide Security Question

New Contact Person

Relationship Type

Relationship Name

First Name

Please provide First Name

Last Name

Please provide Last Name.

Phone No.

Please provide Phone Number

Please provide Email

Address

Please provide Address

Address 2

City

Please provide City

Country

State

Please provide State

Zip

Please provide Zip

Create User

User Id

Please provide User Id

Password

Please provide Password

Security Question

Please provide Security Question

Confirm Password

Please provide Confirm Password

Security Answer

Please provide Security Answer

License Number

Please provide License Number

Coverage Start Date

Please provide Coverage Start Date

Prior Act Date

If you have current E&O coverage, please enter the retroactive date and upload your declarations page below.

Drop files here or click to upload

In order to qualify, you must certify the below statements are true for you and anyone else for which this insurance will apply:

1. You have not had any claims or policy cancellation/declination (other than non-payment) in the past 5 years.

2. You have not been involved in business brokering, syndications, development of property or exclusive listing agreements with a builder or developer.

3. Your total gross real estate-related revenue, inclusive of all commission and fees, before expenses or any splits has not exceeded $600,000 in the past 12 months and no more than $150,000 of that has come from property management services, appraisal or mortgage brokering services.

4. You do not have more than 25 total licensed, or equivalent, individuals on your Staff.

By clicking Confirm, you acknowledge the above statements are true, you meet the guidelines for coverage, and you agree to the Terms of Service.