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Products
Website Design & Hosting
Social Media Management
Mobile Data Intake
Content Development and Management
About Us
Press & News
Member login
Contact Us
Cloudbridge Advantage Content & Design Form
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Cloudbridge Interest Form
Cloudbridge Advantage Content & Design Form
General Company Information
Company Name
*
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
Max. file size: 128 MB.
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.
A List of Insurance You offer
Contact Us Information
Get a Quote Button
Proud Member of SIAA Logo
Content Block 2
*
Please choose what feature you would like in block 2.
A List of Insurance You offer
Contact Us Information
Get a Quote Button
Proud Member of SIAA Logo
Content Block 3
*
Please choose what feature you would like in block 3.
A List of Insurance You offer
Contact Us Information
Get a Quote Button
Proud Member of SIAA Logo
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
Max. file size: 128 MB.
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
Select files
Accepted file types: doc, docx, rtf, txt, pdf, pages, Max. file size: 128 MB, Max. files: 10.
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
Select files
Accepted file types: doc, docx, rtf, txt, pdf, pages, Max. file size: 128 MB, Max. files: 10.
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
Name
This field is for validation purposes and should be left unchanged.