Cloudbridge Advantage Content & Design Form

HomeCloudbridge Interest FormCloudbridge Advantage Content & Design Form

General Company Information
Company Name*
Address*
Street Address City State ZIP Code
Company Phone Number*
Company Fax Number
Current General Email*
Hours of Operation*
Monday: 8:00am - 5:00pm Tuesday: 8:00am - 5:00pm Wednesday: 8:00am - 5:00pm Thursday: 8:00am - 5:00pm Friday: 8:00am - 5:00pm
Company Logo
Upload Company Logo
Domain Name Information
Looking for that perfect domain name? See if it's available at: https://instantdomainsearch.com
Do you own your domain name or do you need us to purchase it?*
- I own my own domain
- I need Cloudbridge to purchase my domain name for me
What is Your Domain Name?*
Where is Your Domain Registered?
What are Your Domain Credentials? (User and Password Information)
We ask for this information in order to complete your domain transfer so that your site can go live. Transfer times vary.
What is Your Desired Domain Name?*
Content Block 1*
Please choose what feature you would like in block 1.
Content Block 2*
Please choose what feature you would like in block 2.
Content Block 3*
Please choose what feature you would like in block 3.
About Us Page Information
About Us Text
If no text is provided, we will utilize default text provided by the SIAA Marketing Department.

Preview Default About Us Cloudbridge Text here.
Will You Be Providing Agent Bio's and Photos for Your Website?*
- Yes
- No
Agent Biographies
Please upload all of your Agent's Biographies in a single Word Document. We will format the text and match it with each agents' photo and contact information.
Agent's Biographies
For each agent, please include: Photo, Name, Phone Number, E-Mail, Biography
Contact Us Page Information
Email for all "Contact Us" Requests to be Submitted
Types of Insurance Provided
What Type of Insurance Do You Provide?*
- Auto Insurance
- Boat Insurance
- Commercial/Business Insurance
- Health Insurance
- Homeowners Insurance
- Life Insurance
- Motorcycle Insurance
- Personal Insurance
- RV Insurance
- Renters Insurance
- Umbrella Insurance
- Workers Compensation
- Other

Other Types of Insurance:

Types of Insurance Custom Content
As we do not have, or write content for insurance types that are not on the default list, if you offer insurance types that are outside of the default list, please upload a document that contains all of the content you'd like on their respective pages here.
Drop files here or

Accepted file types: doc, docx, rtf, txt, pdf, pages.
Do you want to use default or custom content text for the Types of Insurance?
Preview Default Cloudbridge Text here.
- I would like to use the default content text (Most Popular)
- I would like to use my own custom content text
Types of Insurance Custom Content
Please upload documents here that have your custom insurance text.
Drop files here or

Accepted file types: doc, docx, rtf, txt, pdf, pages.
Insurance Carrier Page Information
Please Choose What Insurance Carriers You Represent*
- Allied
- Allstate
- American Modern
- AmTrust
- Dairyland Auto & Cycle
- Encompass
- Foremost
- Grange Mutual
- Guard
- Hagerty
- Hanover
- The Hartford
- Liberty Mutual
- Main Street America
- Mapfe Insurance
- Merchants
- MetLife
- National General Insurance
- Safeco Insurance
- State Auto
- Titan Insurance
- Travelers
- Other

Other Insurance Carriers You Represent*

Quoting Method
Do you Use a third party rating engine for online quotes? If not, you have the option of adding a contact form so that leads will come to you directly. If you use a quoting engine, please provide the URL below.
Third Party Rating Engine Method*
- EZ Lynx/Agent Insure/Vertafore/etc...
- I'd like to use a Contact Form
What email address would you like Quote Requests sent to?*
Third Party Rating Service URL:
Social Media Links
Please provide us with your social media URL's so we can add these to your website!
Social Media Platform
- Twitter
- Facebook
- LinkedIn
- Xing
- Renren
- Google+
- Disqus
- LinkedIn Pulse
- Snapchat
- Tumblr
- Pinterest
- Twoo
- MyMFB
- YouTube
- Instagram
- Vine
- WhatsApp
- vk.com
- Meetup
- Secret
- Medium
Social Media Link
Privacy Policy
A Privacy Policy is required for your website. SIAA provides a default that you can read below, or if you choose, you may provide your own. Click the link below to view our Privacy Policy: Cloudbridge Privacy Policy
Privacy Policy (Please select one)*
- I consent to adding the default SIAA Privacy Policy linked above
- I have my own Privacy Policy
Website Service Agreement
By clicking the checkbox below you are agreeing to the Website Services Agreement between your company an Cloudbridge Solutions.
I agree with the website services agreement as described in the above link.*
- I AGREE WITH THE WEBSITE SERVICES AGREEMENT
ACH Payment Form
By checking this box you agree that you must fill out the ACH Payment Agreement and send it back to "Forms@CloudbridgeSolutions.com" before my website will enter the development queue.

ACH Payment Form
I understand I must send in the above ACH Form prior to my website entering the development queue.*
- I UNDERSTAND I MUST FILL OUT THE ACH FORM TO COMPLETE REGISTRATION
Email
This field is for validation purposes and should be left unchanged.

Cloudbridge Solutions

Address: 496 Wallis Rd, Rye, NH 03870
Email: support@cloudbridgesolutions.com
Hours: Monday - Friday | 9am to 5pm

Cloudbridge Advantage Content & Design Form

General Company Information

Company Logo

Domain Name Information

About Us Page Information

Agent Biographies

Contact Us Page Information

Types of Insurance Provided

Insurance Carrier Page Information

Quoting Method

Social Media Links

Privacy Policy

Website Service Agreement

ACH Payment Form

Cloudbridge Solutions

OTHER HELPFUL LINKS