The Development of Online Forms

 

     I had a "dream". This dream is to be able to send the entire Online Form back to you. Currently, technology only allows the return of form 'data' from any HTML form.
 
EXAMPLE: When an applicant fills out the "General Agent Application" you receive this:

General_Agent_Name: Greg Schipper
Agent_Form_Date: 11-18-02
Agent_Social_Security_No: 555-77-8888
GA_Supp_GenAgent: Greg Schipper
GA_Supp_Regional: Bart Dailey
GA_Sign_Commission: Greg Schipper
Commission_AmAmicable: ON
Commission_PioneerAm:
Commission_Pioneer_Security:
Date: November 18, 2002


    I personally think this is unacceptable. For a "Legal" document, we should have the entire form! Microsoft has no solution. Adobe Acrobat has a multi-thousand dollar solution that is very complex, expensive and time consuming! That's no solution.
 
     Several weeks ago, the Lord placed this "dream" in my heart, and since then we've invested time and talent to develop a simple solution. Here's what we have now... The entire form below was actually sent to me complete from the server, and setup time was less than 1 hour! It prints out a "legal agreement", just like the original the client filled out. Now that's a solution! Think of all the ways this could be used:

   • Create and send a proposal online; a copy to the client and one to the office. (from anywhere)

  • Place your important contracts online, customers fill-out and click "Send". Save on FedEx.
  • Create and send an invoice online; send to the client and copy the office. (from anywhere)

  • Convert any legal form that must be faxed or mailed, use your creativity.


Sincerely,
Greg Schipper

 

Take a look below. This is an "actual" form returned by email with the data intact.
 

 

AMERICAN AMICABLE LIFE INSURANCE COMPANY OF TEXAS

 

GENERAL AGENT CONTRACT & SUPPLEMENT

 

     This agreement is a Supplement to the Agent's Contract between

      (Type Your Name Here) (Second Party) and

 

    AMERICAN‑AMICABLE LIFE INSURANCE COMPANY OF TEXAS

 (the Company, First Party) dated (Date Here) and is effective                .

 

         Social Security:(Enter your Social Security Number)

 

     Said Company does hereby appoint second party as General Agent for the purpose of procuring in person or through agents recruited by him or assigned to him by the Company, applications for insurance in said Company.  The second party may, subject to Company approval, appoint and make contracts with subordinate agents, and the Company may assign to second party subordinate agents who shall be deemed to have been approved and accepted by him unless rejected in writing by the second party within ten days from such assignment.

 

     The power and authority of second party to act for and upon behalf of the Company is strictly limited to the terms and provisions hereof, and nothing herein contained shall be construed to grant to said second party, by implication or otherwise, any right, power, authority or privilege that is not herein specifically set forth.

 

     This Supplement, together with the Agent's Contract identified above, shall constitute the entire agreement between the parties hereto and cannot be modified by any prior or subsequent verbal promise or statement, by whomsoever made, and no supplement hereto shall be binding upon the Company until it shall have been approved and executed in writing upon behalf of the Company at the Home Office by its President, a Vice President, or its Secretary.

 

 By:                                            By:

         (Second Party, General Agent)                                                (Regional Director)

 

  ______________________________________

   (First Party, American Amicable Life Ins. Co. of Texas)

                                                        

 

  __________________________________     __________________________________ 

    Company Approval                                                  Effective Date

 

      

 X   (GA's name here as approval signature)

 

    American Amicable Life Insurance Company                     

     Pioneer American Insurance Company Regional Manager

    Pioneer Security Life Insurance Company

 5674 (3/01)