Agency Mission Statement, Slogan, or Statement of Purpose.

• This page will include a descripton of coverages/products your agency provides and a listing of companies you represent.  
  Describe your agency's coverages/products.  Please indicate the product name, followed by a brief descripton.
  
  

• Please list the top eight companies you represent (and web address if known)
  
  

VI.     Request a Quote

This page will include standardized forms for particular coverages that can be filled in by a consumer visiting your website.  The information will then be e-mailed to the NEW email address that comes with your site for follow-up. If you do not wish to take advantage of this free email address, please email Rachel Vose at rvose@piiai.org or call her at (800) 628-6436, ext. 3024 and let her know. ** Unless you indicate a different email address, the quote forms will go to your NEW email address which will be info@youragencyname.com. This NEW email address will have to be set up on your computer or will have to be checked via web-based email.  **

  Please indicate the forms you would like included on your website:

	Homeowners		Life
	Auto		Business
	Health		Miscellaneous

 

This page will provide an overbiew and/or history of your agency.     

VIII.    Contact Us

• This page will include a contact form that a consumer can e-mail to you along with a listing of up to 10 staff members.  If you are using a PIIAI web template, you will receilve one e-mail address for your agency.  Individual e-mail boxes can be secured at an additonal charge, at the end of this form.
  
  Indicate your agency's hours:

Staff Name, Title, Phone Extension.  Include E-mail Address if any.

This page will include links to other websites that may be of interest to your visitor. The following links will be automatically included:

1. Choose Independent - The insurance site for Illinois consumers [www.chooseindependent.com]
2. PIIAI - The proffessional Independent Insurance Agents of Illinois  [www.piiai.org]
3. Federal Consumer Information Center - Resource for consumer publications [www.pueblo.gsa.gov]
4. Advocates for Highway and Auto Safety [www.saferoads.org]
5. Kelley Blue Book - new and used car values [www.kbb.com]
6. NADA Guides - used vehicles valuation guides [www.nadaguides.com]
7. The Weather Channel - weather and travel information [www.weather.com]
8. MSN Maps & Directions- maps, directions, and more [http://maps.msn.com]

Please provide six of your own links.  Examples include your local newspaper, Chamber of Commerce, Community service groups.

Name of Agency to add.	Web page address

X.      Additional Services

Additional E-mail boxes are $2 per box, per month, or choose a 10-pak of e-mail boxes for $13.95 per month.    PIIAI templates come with one e-mail box, so please fill in the first e-mail box.  If none are desired, please leave blank, and select "Please establish an account for monthly billing".

Charges less than $10 per month must be billed to a credit card.  Charges in excess of $10 can be billed.  To set up credit card billing, please print out, and fax the credit card payment form.

	Please establish an account for monthly billing.
	I understand that my charges will be more than $10 per month and a to set up payment via credit card. I understand that no other charges will be billed unless they are pre-authorized by me.  (click on credit card payment form, and fax this form to (217) 241-6001)

 

For personal website design or special alterations to your current website, please contact EOS, inc. at (800) 241-6006 for consultation and estimates.