Electronic Signature Agreement

Electronic Transaction Disclosure

You are now formally applying for insurance on this web site. This means you are entering into a transaction with Northwest Insurance Network,Inc electronically. By doing so, you are consenting to “electronically sign” your insurance application and state-mandated forms rather than signing paper copies. You may withdraw your consent to conduct this insurance purchase electronically by terminating this session at any time before your transaction is completed.

If you wish to retain a printed copy of your application, you may utilize your browser’s print feature to print a hardcopy of any screens you wish to retain. Northwest can also provide you with a hardcopy of your application by calling (312) 427-1777.

We make every effort to ensure that this web site works properly on the latest versions of Chrome, Firefox, Internet Explorer and Safari. This site requires cookies and JavaScript to be enabled. Use of your browser’s “Back” button is discouraged, please use the “Back” button at the bottom of each form instead.

If you are unable to use the site for whatever reason, our operators are available at (312) 427-1777 during normal business hours to assist you with obtaining an insurance policy.