USER ACCESS FORM

is American Reliable's new automated quote, issuance and policy maintenance system. This new system offers the same ease of use as our Web rater but offers enhanced features including:

  • Quick Quote
  • Policy issuance with a single key stroke
  • Multiple payment options
  • Credit card payments
  • Ability to initiate Endorsements and Cancellations
  • Billing and payment inquiry
  • Paper applications are no longer needed

Signing up is quick and easy. Complete the form below for each person who will be accessing this new system.


*Indicates a required field

*Agency Name:
*Agency Code with American Reliable Insurance Company®:
DBA (if applicable):
*Agency Street Address:
*Agency City, State, Zip:
*Agency Phone Number:
Agency Email (if applicable):
*User First Name:
*User Last Name:
User Email (if applicable):
*User Phone Number:
Extension:
User Fax Number:
*New/Changed Access Requested By:
Requester Phone Number:
Extension:
Notes: