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	Diversified Insurance Services 105 Monterey Lane Bullard, TX 75757 (877) 596-8504	Sign up below or call 877-596-8504 for assistance.
	DISCRIPTION OF ADVERTISING SERVICES OFFERED Diversified Insurance Services owns and operates Insbuyer.com. We offer advertising space on Insbuyer.com to agents, agencies and companies who want to reach our audience. In 2009 we had over 900,000 consumers complete our consumer profile form and request a quote. Listing your business in our advertisers database will allow you to reach those consumer in your area that are looking for product you offer. This is a very cost effective way of generating sales leads and expanding your book of business. Listing are sold under the following terms: $50 per month with no long term contract. $40 per month with a 12 month contract. $400 paid annually for 12 months of service. Money Back Guarantee: Diversified Insurance Services guarantees a minimum of 100 leads will be sent to each advertiser over the course of 12 months. Advertisers must be in the program for 12 consecutive months to be eligible for the money back guarantee. Monthly subscribers will be billed for the first 3 months when establishing new service. Subsequent payments will be made on a monthly basis and according to the terms chosen by the advertiser. There are no additional charges for leads or set up. You can list your business in up to 5 states with NO additional cost. This is a recurring fee and contracts renew automatically on the renewal date unless "Advertiser" notifies Diversified Insurance Services of their intention not to renew. 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: How did you find InsBuyer.com? Google Home Office Insurance News Net Found on Web SELECT THE STATES IN WHICH YOU WANT YOUR BUSINESS LISTED State:   AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY State:   AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY State:   AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY State:   AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY State:   AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY SELECT THE AREAS IN WHICH YOU WANT TO GENERATE LEADS Annuities Auto Ins. Accident Ins. Business Ins. Boat/Watercraft Cancer Ins. Cobra Critical Illness Disability Ins. Dental Ins. Earthquake Ins. Employee Benefits Estate Planning Flood Ins. Health Savings Accounts Health Ins. Home Ins. Home Health Care Hospitalization IRA's Liability Ins. Life Ins. Long Term Care Medicare Supplements Mobile Home Mortgage Life Motorcycle Ins. Renters Ins. Retirement Planning Recreational Vehicle Travel Ins. 401k Rollover Apartment Building Ins. Payment Information (Visa, Mastercard, American Express, Discover & PayPal) Payment Type Paypal 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*      Monthly subscribers billed for first 3 months and then monthly Mo. 1 2 3 4 5 6 7 8 9 10 11 12 Year 2010 2011 2012 2013 2014 2015      $50 Monthly   $40 Mo. x 12   $400 Annual 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: *Internet Advertising on InsBuyer.com *Cost $50 per month with a 3 month minimum. *Cost $40 per month with a 12 month contract. (First 3 months paid at conception of contarct.) *Cost $400 per year paid annually. *Fee includes database listing and unlimited leads. Money Back Guarantee: Diversified Insurance Services guarantees a minimum of 100 leads will be sent to each advertiser over the course of 12 months. Advertisers must be in the program for 12 consecutive months to be eligible for the money back guarantee. Protected Territories: Diversified Insurance Services agrees to limit the number of advertisers in our advertisers database to one (1) per zip code. Canceling 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 Web site. 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 Web site. 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 authorized 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 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 canceling your subscription. Advertisers useing the PayPal subscription option will have their PayPal account debited on their anniversary date according to the terms on the subscription option choosen. We may renew your subscription without further authorization from you if you do not contact us and request your listing(s) be cancelled. Please contact the InsBuyer.com <A href="dis_cancellation.asp">Cancellation Department</a>(http://www.insbuyer.com/dis_cancellation.asp) to cancel your automatic renewal, cancel your subscription, or change your payment method contact the Renewal Department at www.insbuyer.com/dis_renewal.asp, call 877-596-8504 or send your request by mail to the address below. Diversified Insurance Services 105 Monterey Lane Bullard, TX 75757 (903) 825-7785 Please print this page for your own records.