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Electric Insurance Affiliate Program Contact Form

Electric Insurance tracks site traffic origination and pays non-insurance-licensed affiliates on a completed-quote basis. When a visitor comes to Electric Insurance through the EIC button on the affiliate site and finishes the auto quote process through to the last step where they receive a policy price quote, they qualify as a "completed-quote." Electric Insurance pays a referral fee to the affiliate site for each of these completed-quote visitors.

To receive more information, apply for affiliate status or recieve a copy of the Standard Affiliate Program Agreement, please submit the following information:


Contact Information:

Contact first name:
Contact last name:
Title:
Company name:
Street address:
Street address 2:
City:
State:
Zip:
Phone:
Fax:
E-mail:

Site Information:

Website URL:
Primary business: (eg, insurance, automotive, etc.)
Number of site visitors, monthly:
Number of visitors expecting to send
to Electric Insurance, monthly: