Diversified Insurance Services 16321 W. 344 W., Suite 6 Bullard, TX 75757 (877) 596-8504
	TERMS OF ADVERTISING AGREEMENT Diversified Insurance Services owns and operates Insbuyer.com. We offering advertising space on Insbuyer.com to agents, agencies and companies who want to reach our audience. The cost of advertising is $500 for the first 12 months. There are no additional charges for leads or set up. There is a Recurring Annual fee of $300 for each year this contract remains in force. Contracts renew automatically on renewal date unless "Advertiser" notifies Diversified Insurance Services of their intention not to renew. Reminder Renewal notices will be sent out in advance of renewal. Please review our Terms of Advertising and complete the form below. Space is limited so don't delay! Company Name: Contact: Address: City: State: Zip: Local Phone # Toll Free # FAX # E-mail: Company Web Site URL: Referring Company: Who referred you to InsBuyer.com? Google Smart Agent Agency Insurance News Net Insurance IQ Found on Web SELECT THE AREAS IN WHICH YOU OFFER COVERAGE Please use the space below to list years of exp., specialities, mission statement etc... Annuities Auto Ins. Business Ins. Cobra Dental Ins. Disability Ins. Earthquake Ins. Employee Benefits Estate Planning Farmer Ins. Flood Ins. Health Ins. Home Ins. IRA's Liability Ins. Life Ins. Long-term Care Medical Savings Accounts Mobile Home Mortgage Ins. Medicare Supplements Motorcycle Ins. Pension Planning Pet Ins. Profit-sharing Renters Ins. Retirement Planning Sec. 125 Plans SEP Title Ins. Travel Ins. 401k 403b Payment Information (Visa, Mastercard, American Express & Discover, Check) Payment Type Pay by Check Visa MasterCard American Express Discover/NOVUS Name as it appears on your card* Billing address for your card* Card Number* (spaces and dashes may be used) Expiration Date*        Security Code       Amount Billed* Mo. 1 2 3 4 5 6 7 8 9 10 11 12 Year 2007 2008 2009 2010 2011 2012            $500 By submitting, I agree to the Terms of Advertising Agreement. I accept: Terms of Advertising Agreement Diversified Insurance Services owns and operates InsBuyer.com. Description of Services: Insbuyer.com Internet Advertising Subscription Fee $500 (Term of Service 1yr.) Fee includes database listing, quote page construction and hosting. Unlimited leads from up to 5 states. Cancelling Subscription Services: You may terminate Subscription Services at any time by contacting our office. The cancellation of your listing is your only remedy with respect to any such dispute that you may have with us. We will attempt to process all cancellation requests within 72 hours after we receive your request. Any such termination or cancellation is subject to the no-refund policy described below and NO refunds will be made. Upon any termination or cancellation of your Subscription Services, we may immediately deactivate or delete your listing and all related information and/or bar any further access by you to the Website. Payment: Prices for all Subscription Services exclude all applicable taxes and telecommunication charges, unless expressly stated otherwise. To the extent permissible under law, you are responsible for any applicable taxes, whether or not they are listed on your receipt or statement. If you purchase Subscription Services, you agree to pay, using a valid credit card (or other form of payment that we may accept from time to time), the applicable fees and taxes (if any) set forth on the Website. We reserve the right, upon prior notice to you, to change the amount of any fees and to institute new fees, effective at the end of your current subscription period. All authorised charges will be billed to your designated credit card account (or other payment method) on the terms described in the specific offer. If payment cannot be charged to your credit card or your payment is returned to Diversified Insurance Services for any reason, Diversified Insurance Services reserves the right to either suspend or terminate your access to the unpaid-for Subscription Services. Refund Policy: Payment for advertising on InsBuyer.com is non-refundable. No refunds will be made on accounts when advertisers cancel during their term of service. Automatic Renewal Program: Advertisers participating in the InsBuyer.com lead program are subject to the Automatic Renewal Program. Diversified Insurance Services will send an Automatic Renewal Notice Reminder via email to the advertiser notifying them of the pending renewal. Diversified Insurance Services will automatically renew your subscription on the anniversary of your purchase to ensure that there is no interruption of leads. Diversified Insurance Services will charge your credit card at the then-current renewal rate using the credit card information we have on file for your account, unless you provide Diversified Insurance Services with prior notice that you are cancelling your subscription. We may renew your subscription without further authorisation from you if you do not contact us and request your listing(s) be cancelled. Please contact the InsBuyer.com Cancellation Department (http://www.insbuyer.com/dis_cancellation.asp) to cancel your automatic renewal, cancel your subscription, or change your payment method contact the Renewal Department (http://www.insbuyer.com/dis_renewal.asp). Diversified Insurance Services 16321 FM 344 W. Suite 6 Bullard, Tx 75757 (903) 825-7785 Please print this page for your own records. To list your business in multiple states call 1-877-596-8504.