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New Agent - Broker Appointment Request for Residential Earthquake Insurance

GeoVera specializes in providing standalone residential earthquake insurance. If you are interested in teaming up with GeoVera to offer these superior earthquake insurance products to your clients, simply complete the form below. Once your application for appointment has been approved, you will obtain access to:

  • Quick Estimates in less than 30 seconds with GeoVera’s easy, instant earthquake insurance quoting website

  • Online  payments for your earthquake insurance clients

  • Online commission statements

  • Online earthquake insurance policy inquiry

Note: The agency must have a valid insurance license for the state the product is offered in, and the license effective date must not be expired. If the application for appointment is approved, GeoVera will collect your licensing information at that time.


Residential Earthquake Insurance

  Available in California, Oregon and Washington

Agency Name:
Type of Business:
Year Established:
Tax ID Number or SSN:
Agency Contact Name:
Job Title:
Mailing Address:
Is your Street Address the same as your Mailing Address?

Street Address:
Marketing Area:

List the City, State and/or County which is your main marketing area
Top 3 Personal Lines Carriers:

Average number of HO policies written per month:
Anticipated monthly number of applications for GeoVera new business:
Do you have a market you would like to move to GeoVera?
If yes, provide Name of Carrier:
If yes, estimated volume:
This question is for testing whether you are a human visitor and to prevent automated spam submissions.



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