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registration.usassure.com Open in urlscan Pro
20.69.231.113  Public Scan

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Submitted URL: https://info.usassure.com/MzgxLUlTTy01MTAAAAGSSGl9wNsMOry2WuZYepXj9yu8Hdy-h9JI-dLqMtFIiCkesXx9nAnbfk6TuPYZxx-hSnxe0ra73IXN...
Effective URL: https://registration.usassure.com/?utm_source=marketo&utm_medium=email&utm_campaign=br-es-2024-04-04-lead-outreach&mkt_tok=MzgxLUl...
Submission: On April 04 via api from US — Scanned from DE

Form analysis 2 forms found in the DOM

<form id="form1">
  <div id="Wrapper" class="fullwidth">
    <div id="HeaderWrapper" class="fullwidth">
      <div id="Header" class="sitewidth">
        <a href="https://usassure.com/?utm_source=registration&amp;utm_medium=web&amp;utm_campaign=logo">
        <div class="logo">
            <img src="/Images/logo.png" alt="US Assure" title="US Assure">
        </div>
    </a>
        <div class="spacer"></div>
        <div class="divider"></div>
        <div id="GlobalNav" class="navDelay">
          <div class="sfNavWrp sfNavHorizontalDropDownWrp">
          </div>
        </div>
        <div id="SearchWrap">
          <div id="GlobalSearch">
            <div class="sfSearchBox">
              <input id="GlobalSearchText" type="text" data-source-url="https://usassure.com" class="sfsearchTxt" placeholder="Search">
              <input type="submit" id="GlobalSearchSubmit" onclick="siteSearch(); return false;" class="sfsearchSubmit">
            </div>
          </div>
        </div>
        <div class="clear">&nbsp;</div>
      </div>
    </div>
  </div>
</form>

POST 

<form id="WelcomeForm" method="post" novalidate="novalidate">
  <div class="row">
    <div class="col-md-2">
      <div class="guide-image">
        <a href="https://go.usassure.com/rs/381-ISO-510/images/us-assure-how-to-register-guide.pdf" target="_blank">
                    <img src="/Images/Web_Banner.png">
                </a>
      </div>
    </div>
    <div class="col-md-10">
      <div class="row">
        <div class="col-md-12">
          <h1>Create your account now. Become an agent today!</h1>
        </div>
      </div>
      <div class="row">
        <div class="col-md-12">
          <p><span style="font-weight: bold;">Are you a licensed insurance agent?</span> When you register with US Assure, you’ll receive:</p>
          <ul>
            <li>Quick product access</li>
            <li>Online policy issuance with no minimum volume commitment</li>
            <li>Service support from a team of more than 50 builders risk specialists</li>
          </ul>
          <p>Set up your account in minutes and get instant access to quote and issue our “A” rated construction and property insurance products.</p>
        </div>
      </div>
      <div class="row section">
        <div class="col-md-12">
          <p style="font-weight: bold;">Tell us where you'd like to begin.</p>
          <p><input id="sectionSelection" name="sectionSelection" type="radio" value="New"> I wish to register as a new licensed insurance professional with US Assure.</p>
          <p><input id="sectionSelection" name="sectionSelection" type="radio" value="Existing"> I previously started a registration and am returning to complete the process.</p>
          <p><input id="sectionSelection" name="sectionSelection" type="radio" value="Existing"> I have an existing relationship and online account with US Assure but need access to other property insurance programs. </p>
        </div>
      </div>
    </div>
  </div>
  <div id="existingSection" style="display: none;">
    <div class="row section">
      <div class="col-md-2 sidebar">
        <h2>Email</h2>
      </div>
      <div class="col-md-4">
        <div>
          <p><span style="font-weight: bold;">Please enter your email address</span></p>
          <div class="form-group has-feedback">
            <p>
              <input id="existingEmailAddress" name="existingEmailAddress" placeholder="Email Address" type="text" value="">
            </p>
            <p id="feedbackText" style="color: red;"></p>
            <p></p>
          </div>
          <p><span data-valmsg-for="EmailAddress" data-valmsg-replace="true" data-valmsg-custom="EmailAddress" class=""></span></p>
        </div>
      </div>
    </div>
    <div class="row section">
      <div class="col-md-2"> &nbsp; </div>
      <div class="col-md-10">
        <button type="button" id="continueRegistrationButton" data-url="/GetRegistrationByEmail" data-url1="/continue" style="width: 150px;">Find My Account<span class="glyphicon glyphicon-play"></span></button>
      </div>
    </div>
  </div>
  <div id="newSection" style="display: none;">
    <div class="row section">
      <div class="col-md-2 sidebar">
        <h2>Email</h2>
      </div>
      <div class="col-md-4">
        <p><span style="font-weight: bold;">Please enter your email address</span></p>
        <div class="form-group has-feedback">
          <p>
            <input data-url="/RequestValidateEmail" data-url1="/GetRegistrationByEmailFromRegisterScreen" data-val="true" data-val-custom="EmailAddress"
              data-val-length="<span style=&quot;font-weight: bold;&quot;>Email Address</span> must be between 0 and 320 character(s)" data-val-length-max="320" data-val-length-min="0"
              data-val-required="<span style=&quot;font-weight: bold;&quot;>Email Address</span> is required" id="EmailAddress" name="EmailAddress" placeholder="Email Address" type="text" value="" data-original-title="" title="">
            <i id="emailAddressValidationIcon" class="val_icon form-control-feedback glyphicon"></i>
          </p>
        </div>
        <p><span data-valmsg-for="EmailAddress" data-valmsg-replace="true" data-valmsg-custom="EmailAddress" class=""></span></p>
        <div class="form-group has-feedback">
          <p>
            <input data-val="true" data-val-custom="ConfirmEmailAddress" data-val-custom-compareto="EmailAddress" data-val-custom-valmsg="ConfirmEmailAddress"
              data-val-required="<span style=&quot;font-weight: bold;&quot;>Confirm Email Address</span> is required" id="ConfirmEmailAddress" name="ConfirmEmailAddress" placeholder="Confirm Email Address" type="text" value="">
            <i id="confirmEmailAddressValidationIcon" class="val_icon form-control-feedback glyphicon"></i>
          </p>
          <p><span data-valmsg-for="ConfirmEmailAddress" data-valmsg-replace="true" data-valmsg-custom="ConfirmEmailAddress" class=""></span></p>
        </div>
      </div>
    </div>
    <div id="TerritorySection" class="row section ">
      <div class="col-md-2 sidebar">
        <h2>Office Location</h2>
      </div>
      <div class="col-md-10">
        <div id="Territory">
          <p>Where does your insurance office conduct business:</p>
          <p><input checked="checked" disabled="true" id="Territory" name="Territory" type="radio" value="United States"> United States</p>
          <input type="hidden" name="Territory" id="Territory" value="United States">
        </div>
      </div>
    </div>
    <div id="StateSelection" class="row section">
      <div class="col-md-4 col-md-offset-2">
        <p>In what state is your insurance office located?</p>
        <select data-val="true" data-val-custom="Address" data-val-required="<span style=&quot;font-weight: bold;&quot;>State</span> is required" id="StateDDL" name="State" onchange="StateChange()">
          <option value="">State</option>
          <option value="AK">Alaska</option>
          <option value="AL">Alabama</option>
          <option value="AR">Arkansas</option>
          <option value="AZ">Arizona</option>
          <option value="CA">California</option>
          <option value="CO">Colorado</option>
          <option value="CT">Connecticut</option>
          <option value="DC">District of Columbia</option>
          <option value="DE">Delaware</option>
          <option value="FL">Florida</option>
          <option value="GA">Georgia</option>
          <option value="HI">Hawaii</option>
          <option value="IA">Iowa</option>
          <option value="ID">Idaho</option>
          <option value="IL">Illinois</option>
          <option value="IN">Indiana</option>
          <option value="KS">Kansas</option>
          <option value="KY">Kentucky</option>
          <option value="LA">Louisiana</option>
          <option value="MA">Massachusetts</option>
          <option value="MD">Maryland</option>
          <option value="ME">Maine</option>
          <option value="MI">Michigan</option>
          <option value="MN">Minnesota</option>
          <option value="MO">Missouri</option>
          <option value="MS">Mississippi</option>
          <option value="MT">Montana</option>
          <option value="NC">North Carolina</option>
          <option value="ND">North Dakota</option>
          <option value="NE">Nebraska</option>
          <option value="NH">New Hampshire</option>
          <option value="NJ">New Jersey</option>
          <option value="NM">New Mexico</option>
          <option value="NV">Nevada</option>
          <option value="NY">New York</option>
          <option value="OH">Ohio</option>
          <option value="OK">Oklahoma</option>
          <option value="OR">Oregon</option>
          <option value="PA">Pennsylvania</option>
          <option value="RI">Rhode Island</option>
          <option value="SC">South Carolina</option>
          <option value="SD">South Dakota</option>
          <option value="TN">Tennessee</option>
          <option value="TX">Texas</option>
          <option value="UT">Utah</option>
          <option value="VA">Virginia</option>
          <option value="VT">Vermont</option>
          <option value="WA">Washington</option>
          <option value="WI">Wisconsin</option>
          <option value="WV">West Virginia</option>
          <option value="WY">Wyoming</option>
        </select>
        <p><span data-valmsg-for="State" data-valmsg-replace="true" data-valmsg-custom="State" class=""></span></p>
      </div>
    </div>
    <div id="AffiliationSection" class="row section">
      <div class="col-md-2 sidebar">
        <h2>Business Affiliation</h2>
      </div>
      <div id="USAffiliation" class="col-md-10">
        <p><strong>Select a description below that best identifies your business relationship and method of access to US Assure. Your selection will impact product access, policy billing and reporting, and commission payment.</strong></p>
        <p>
          <input type="radio" name="AffiliationRadio" onclick="setUSAffiliation('Zurich')"> <strong>My agency has a direct appointment with Zurich for builders risk</strong><br>
        </p>
        <p> &nbsp;&nbsp;&nbsp;&nbsp;(If your agency has an existing relationship, your producer code includes all numerical characters.) </p>
        <p>
          <input type="radio" name="AffiliationRadio" onclick="setUSAffiliation('Independent')">
          <strong> I am an independent insurance professional whose agency has no direct appointment with Zurich and no affiliation</strong>
        </p>
        <p>&nbsp;&nbsp;&nbsp;&nbsp;(If your agency has an existing relationship, your producer code begins with the letter “A”.)</p>
        <p style="display: block;">
          <input value="Other" type="radio" name="AffiliationRadio" onclick="
                           openAffiliationDropDown()"> <strong>My agency has an affiliation:</strong>
        </p>
        <p>&nbsp;&nbsp;&nbsp;&nbsp;(e.g. Farmers, Allstate, Nationwide, MetLife, etc.)</p>
        <div class="row" style="display: block;">
          <div class="col-md-6">
            <select id="AffiliationSelect" disabled="" onchange="getAffiliationFromSelect()">
              <option value="Other">Affiliation</option>
              <option value="Kraft">Farmers/Kraft Lake Insurance Agency</option>
              <option value="Allstate">Ivantage/Northeast Agencies (NEA)</option>
              <option value="Intermediaries">Nationwide Brokerage Solutions</option>
            </select>
          </div>
        </div>
      </div>
      <div id="CAAffiliation" class="col-md-10 hidden">
        <p>Are you an appointed agent/broker with Zurich?</p>
        <p>
          <input type="radio" name="CAAffiliation" value="Yes" onclick="appointedPopup()"> Yes
        </p>
        <p>
          <input type="radio" name="CAAffiliation" value="No" onclick="openDomicileQuestion()"> No
        </p>
        <div id="CADomicile" class="hidden">
          <p>&nbsp;</p>
          <p>Are you domiciled in Ontario?</p>
          <p>
            <input type="radio" name="Domicile" value="Yes" onclick="setAffiliation('CanadaIndependent')"> Yes
          </p>
          <p>
            <input type="radio" name="Domicile" value="No" onclick="domicilePopup()"> No
          </p>
        </div>
      </div>
    </div>
    <div class="row section">
      <div class="col-md-4 col-md-offset-2">
        <button id="WelcomeButton" type="submit" style="width: 150px;" class="form-group submitButton" disabled="">Continue<span class="glyphicon glyphicon-play"></span></button>
      </div>
    </div>
  </div>
  <div id="appointedModal" class="modal fade">
    <div class="modal-dialog">
      <div class="modal-content">
        <div class="modal-header">
          <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button>
          <h2>Attention Zurich Appointed Broker</h2>
        </div>
        <div class="modal-body">
          <p>As an appointed broker with Zurich and for added convenience, we have already reserved an online account for you. Contact our PC&amp;L team at (888) 888 - 9883, option 1 then 3, for access instructions.</p>
        </div>
        <div class="modal-footer">
          <button type="button" data-dismiss="modal" style="width: 25%;">OK</button>
        </div>
      </div>
    </div>
  </div>
  <div id="domicileModal" class="modal fade">
    <div class="modal-dialog">
      <div class="modal-content">
        <div class="modal-header">
          <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button>
          <h2>Important Notice for Independent Brokers</h2>
        </div>
        <div class="modal-body">
          <p>At this time, the Builders Risk Plan insured by Zurich is only available in the province of Ontario to brokers who hold no direct contractual appointment with Zurich. We are exploring opportunities to introduce our online course of
            construction products in other areas of Canada. If you would like to receive notification when the Builders Risk Plan insured by Zurich becomes available in your area, email us at <span
              style="font-weight: bold;"><a href="mailto:info@usassure.com">info@usassure.com</a></span>.</p>
        </div>
        <div class="modal-footer">
          <button type="button" data-dismiss="modal" style="width: 25%;">OK</button>
        </div>
      </div>
    </div>
  </div>
  <div id="loginModal" class="modal fade">
  </div>
  <input id="State" name="State" type="hidden" value="">
  <input data-val="true" data-val-required="The ExistingRegistration field is required." id="ExistingRegistration" name="ExistingRegistration" type="hidden" value="False">
  <input id="Affiliation" name="Affiliation" type="hidden" value="">
  <input id="SourceCode" name="SourceCode" type="hidden" value="">
  <input data-val="true" data-val-required="The AllowMAPs field is required." id="AllowMAPs" name="AllowMAPs" type="hidden" value="True">
  <script src="/Scripts/v-637891869555744026/welcome.js"></script>
  <script src="/Scripts/v-637891869553718591/existingEmail.js"></script>
  <script src="/Scripts/v-637891869553748081/formvalidation.js"></script>
</form>

Text Content

 


CREATE YOUR ACCOUNT NOW. BECOME AN AGENT TODAY!

Are you a licensed insurance agent? When you register with US Assure, you’ll
receive:

 * Quick product access
 * Online policy issuance with no minimum volume commitment
 * Service support from a team of more than 50 builders risk specialists

Set up your account in minutes and get instant access to quote and issue our “A”
rated construction and property insurance products.

Tell us where you'd like to begin.

I wish to register as a new licensed insurance professional with US Assure.

I previously started a registration and am returning to complete the process.

I have an existing relationship and online account with US Assure but need
access to other property insurance programs.


EMAIL

Please enter your email address





 
Find My Account


EMAIL

Please enter your email address








OFFICE LOCATION

Where does your insurance office conduct business:

United States

In what state is your insurance office located?

State Alaska Alabama Arkansas Arizona California Colorado Connecticut District
of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas
Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri
Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New
Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island
South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington
Wisconsin West Virginia Wyoming




BUSINESS AFFILIATION

Select a description below that best identifies your business relationship and
method of access to US Assure. Your selection will impact product access, policy
billing and reporting, and commission payment.

My agency has a direct appointment with Zurich for builders risk


    (If your agency has an existing relationship, your producer code includes
all numerical characters.)

I am an independent insurance professional whose agency has no direct
appointment with Zurich and no affiliation

    (If your agency has an existing relationship, your producer code begins with
the letter “A”.)

My agency has an affiliation:

    (e.g. Farmers, Allstate, Nationwide, MetLife, etc.)

Affiliation Farmers/Kraft Lake Insurance Agency Ivantage/Northeast Agencies
(NEA) Nationwide Brokerage Solutions

Are you an appointed agent/broker with Zurich?

Yes

No

 

Are you domiciled in Ontario?

Yes

No

Continue
×


ATTENTION ZURICH APPOINTED BROKER

As an appointed broker with Zurich and for added convenience, we have already
reserved an online account for you. Contact our PC&L team at (888) 888 - 9883,
option 1 then 3, for access instructions.

OK
×


IMPORTANT NOTICE FOR INDEPENDENT BROKERS

At this time, the Builders Risk Plan insured by Zurich is only available in the
province of Ontario to brokers who hold no direct contractual appointment with
Zurich. We are exploring opportunities to introduce our online course of
construction products in other areas of Canada. If you would like to receive
notification when the Builders Risk Plan insured by Zurich becomes available in
your area, email us at info@usassure.com.

OK

Your Partner for Construction and Property Insurance
With more than 40 years of experience, US Assure offers quick product access,
provides online policy issuance and expects no minimum volume commitment to get
started – all while putting our customers at the center of everything we do.
 * US Assure
 * P.O. Box 10197
 * Jacksonville, FL 32247
 * (800) 800 - 3907

--------------------------------------------------------------------------------

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