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Form template · Quote request

Insurance Broker Contact Form Template

Insurance leads are speed-to-quote sensitive — the broker that gets the quote out within an hour of inquiry wins the bind. The form captures line of business and renewal date so the quote process starts immediately.

Use this template — freeSee setup steps
  • 500 free / mo
  • No PHP · no SDK
  • One POST endpoint
Live template preview

Pick your insurance broker contact form — one click to use it

Every template is free and fully editable in the drag-drop builder — swap fields, colors, and the button label before you publish.

Best match
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No backend code

No server, API route, or SDK — your Insurance Broker Contact Form posts straight to one endpoint.

Straight to your inbox

Every submission is emailed to you and saved to a searchable dashboard — spam filtered before it reaches you.

Copy-paste ready

It's plain HTML you own — paste the Insurance Broker Contact Form snippet, swap in your access key, and ship.

Copy and ship

Your Insurance Broker Contact Form, ready to paste.

HTML by default — the same field set also renders as React, Next.js, PHP, and cURL in your dashboard. Every variant posts to the same /api/submit endpoint. Replace YOUR_ACCESS_KEY with the key from your dashboard; that's the only edit.

Use this template — free
form.html
<form action="https://splitforms.com/api/submit" method="POST">
  <input type="hidden" name="access_key" value="YOUR_ACCESS_KEY">
  <input type="hidden" name="subject" value="New quote request">

  <label for="name">Name *</label>
  <input id="name" type="text" name="name" placeholder="Jane Builder" required>
  <label for="email">Email *</label>
  <input id="email" type="email" name="email" placeholder="jane@example.com" required>
  <label for="phone">Phone *</label>
  <input id="phone" type="tel" name="phone" placeholder="+1 415 555 0142" required>
  <label for="company">Company</label>
  <input id="company" type="text" name="company" placeholder="Acme Inc">
  <label for="budget">Budget *</label>
  <select id="budget" name="budget" required>
    <option value="">Choose…</option>
    <option>&lt; $5k</option>
    <option>$5k–$15k</option>
    <option>$15k–$50k</option>
    <option>$50k+</option>
  </select>
  <label for="project">Tell us about the project *</label>
  <textarea id="project" name="project" placeholder="Goals, timeline, anything we should know." required></textarea>

  <!-- honeypot — bots fill every field -->
  <input type="checkbox" name="botcheck" style="display:none" tabindex="-1" autocomplete="off">

  <button type="submit">Send</button>
</form><p class="splitforms-attribution" style="margin-top:12px;font-size:11px;color:#888;text-align:right">
  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="sponsored noopener">splitforms</a>
</p>

How to add it

How to add a Insurance Broker Contact Form to your site.

To add a Insurance Broker Contact Form to your site you need three things: a free splitforms access key, the HTML snippet above, and your key pasted into it. No backend, database, or CAPTCHA library — the form posts to one URL and every submission lands in your inbox and dashboard.

Capture line of business

Required: line(s) of business (auto / home / life / business / umbrella / health / multi-line — multi-select), current carrier, current renewal date, primary contact info.

Branch by line

Webhook routes by line — auto/home goes to the P&C team queue, life goes to the life specialist, business / commercial goes to the producer who handles BOPs and umbrellas. Different quote workflows, different carriers.

Quote within hours

Webhook to AgencyZoom / EZLynx / Applied Epic — the AMS pre-loads the quote with current carrier and renewal date. Speed-to-quote under 4 hours triples close rate vs next-day. SMS the quote link via Twilio for the highest urgency leads.

Create your formBrowse all templates

What's included

What's in this Insurance Broker Contact Form template?

Independent insurance brokers compete with direct carriers (Geico, Progressive, State Farm) and lead-gen platforms (LendingTree Insurance, EverQuote) — the win is speed-to-quote and personal touch. Brokers earn 10-15% commission on auto/home premiums and 50-100%+ on life policies (year-1). The form captures line of business (auto / home / life / business / umbrella / multi-line), current carrier, renewal date, and basic data (driver count / property address / business revenue depending on line). Speed matters: quotes delivered within 4 hours of inquiry close at 35-45%, vs 10-15% for next-day quotes. Webhook into AgencyZoom / EZLynx / Applied Epic so the AMS pre-loads the quote workflow. Speed-to-quote wins · webhooks into AgencyZoom / EZLynx / Applied / Vertafore.

  • Quote request — 6 ready-made fields
  • HTML, JS, React, PHP, and cURL outputs
  • One POST endpoint, no SDK — honeypot and classifier, no CAPTCHA
What's included with the Insurance Broker Contact Form Template

Where submissions go

Where do your Insurance Broker Contact Form submissions go?

Reply-to is wired to the visitor's email, so one tap on Reply answers them directly — while the built-in honeypot and spam classifier filter out bots before they reach you. Every submission is emailed to your inbox and can forward to a webhook or Slack the moment a visitor hits send.

  • Reply-to wired to the visitor's email — reply straight from your inbox
  • Honeypot and spam classifier filter bots, no CAPTCHA friction
  • Live dashboard, CSV export, and signed webhooks on paid plans
Spam-filtered submissions from the Insurance Broker Contact Form Template

How SplitForms works

From form to workflow in 3 simple steps.

Connect your form, collect every submission, and send data where it needs to go — without building backend infrastructure.

A SplitForms contact form submission launching straight to your inbox

Add your endpoint

Point your form to your unique SplitForms endpoint. That's it.

HTML form pointing at a SplitForms submit endpoint

Receive submissions

We instantly capture and organize every submission in your inbox.

Submissions inbox with searchable leads and status pills

Route anywhere

Send data to email, spreadsheets, CRMs, webhooks, and 7,000+ apps.

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Testimonials

Loved by developers shipping at every scale.

40 quotes on record — from indie hacks to agency migrations.

Next.js
“I replaced a Lambda + DynamoDB + SES contact form with six lines of HTML. It took eleven minutes, and the dashboard is better than what I was going to build.”
Daniel K.Full-stack developer
Agency
“We migrated 14 client sites off Formspree in a single weekend. The price is a third of what we paid, the API is more honest, and the spam filter actually works.”
Priya N.Agency owner
Webhooks
“The webhook payload is signed, idempotent, and well-shaped. It reads like code from a competent team, not a CRUD app held together with duct tape.”
Marcus T.Backend engineer
Marketing
“I stopped reaching for Typeform on small marketing sites. splitforms covers 90% of the use case at none of the bloat.”
Elena R.Freelance designer
MCP
“I onboarded our whole agency in an afternoon. The MCP integration meant Cursor literally dropped the form straight into our client repos for us.”
Sam O.Technical lead
Free plan
“The free plan gave me 500 submissions before I paid a cent, and Pro is five dollars a month. I've spent more on coffee deciding which backend to use.”
Aisha B.Indie hacker
Spam
“Spam went from forty junk entries a day to zero, with no reCAPTCHA puzzle ruining the form. The honeypot and time-trap just quietly do their job.”
Tom W.Webflow consultant
Astro
“Point the form action at one endpoint and you're done. No SDK, no client library, no build step. This is how a form backend should feel.”
Lukas M.Astro developer
Integrations
“Leads land in Slack the second someone submits, and a copy goes to Google Sheets for the sales team. I wired both up in under ten minutes.”
Grace H.Growth marketer
Static site
“I run a static Hugo site on a five-dollar VPS. splitforms gave it a real contact form without me standing up a single server.”
Victor S.DevOps engineer
Read all 40 testimonials →

Questions

Insurance Broker Contact Form questions.

View all FAQs
How do I route by line of business?

The line-of-business multi-select drives the webhook branch. Auto/home (P&C) goes to one Slack channel and AMS workflow; life goes to another (often a different licensed producer); commercial / business goes to a third. Most agencies have specialists per line — the form respects that org structure.

Do I need to mention E&O on the form?

Not on the form itself, but the auto-responder and quote PDFs should reference your agency's E&O coverage and licensing. State insurance departments require disclosure of license numbers in marketing — add to the site footer at minimum, the form's thank-you page ideally.

Can I integrate with AgencyZoom / EZLynx / Applied Epic / Vertafore?

Yes — webhook the JSON. AgencyZoom and EZLynx accept inbound leads via direct webhooks; Applied Epic and Vertafore (HawkSoft) accept via Zapier or their respective AMS APIs. The quote pre-loads with line, current carrier, and renewal date — saves the producer 5-10 minutes per quote.

What about carrier portal / rater integration?

Comparative raters (PL Rating from Vertafore, Tarmika, EZLynx Rating Engine) take the form data and return multi-carrier quotes in 5-15 minutes. Webhook the lead to the rater first; rater results to the producer. End-to-end inquiry-to-quoted-delivery in under an hour is achievable and crushes close rates.

Simple pricing

Start free. Scale when you need more.

Choose a plan that fits your workflow — from a free form endpoint to full automations, exports, and higher submission limits.

Free

$0

Free forever

 
Best for testing

For side projects and indie devs.

  • 500 submissions / mo
  • Unlimited forms
  • Email notifications included
  • Honeypot spam filtering
  • Submissions dashboard
  • MCP setup stays free
  • No credit card required
Get Started
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Pro

$5/ month
was $15 · save 67% · new-user price

For agencies and growing products.

  • 5,000 submissions / mo
  • Unlimited forms
  • Every paid feature included
  • Priority support (under 4hr)
  • 10× free submission volume
  • Cancel anytime
Pre-launch · founders pricing locked in

3-Year

$59/ 36 months
was $99 · save 40% · new-user price

Pay $59. 3 years sorted.

  • 15,000 submissions / mo
  • Unlimited forms
  • Everything in Pro
  • Renews every 3 years
  • Long-term discount
  • Priority support included
  • Vote on the roadmap

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