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 $150 ClaimPrevent Legal Services and $100 Membership fees)

Liability Limits	Per Claim Retention	Total Cost for an Upgrade to Full Prior Acts
Per Incident / Annual Limit	$2500	Backdate coverage to when you were initially licensed
$500,000 / $500,000	$750	$800
$1,000,000 / $1,000,000	$850	$910

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

Coverage Start Date

Please provide Coverage Start Date

Prior Act Date

Please provide Prior Act Date

If you have current E&O coverage, please enter your retroactive date and upload your declarations page below. (Not needed if selecting the option to purchase Full Prior Acts.)

Select your Retention

Please provide Retention

License Number

Please provide License Number

Would you like to purchase Full Prior Acts coverage?

Please provide drop down value

Select your Per Claim/Total Coverage

Please provide Per Claim/Total Coverage

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 $150,000 in the past 12 months AND 80% or more of that is derived from residential (1-4 residential units) services.

4. You have not had any real estate sales/listings over $3,000,000 in the past 3 years.

5. You do not have more than 5 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.