Security First Insurance

storm after storm, year after year.®

Bonus Bucks Score Card

General Information

Agency Name
Agency Participant
Participant Phone
Participant E-Mail Address

If you are a registered participant, you DO NOT need to fax the participant form to us.

If you are not already a registered participant, please click here for registration process and form.

Participant registration may take up to 48 hours. If you are a newly appointed agent, registration may take up to one week. Please check back to complete your Bonus Bucks submissions. If you have any problems, or if you have previously registered as a participant and you do not see your name in the participant list, please email us. This form will be electronically submitted. You may print the form for your records but there is no need to fax the form to us. Manual scorecards are no longer accepted.

Policy Information

Insured Name:
Policy Effective Date: (MM-DD-YYYY)
Policy Number:


NEW: You should see a confirmation page after your entries have been submitted successfully. You will also be able to print from that screen. For your records, it is recommended that you print your submission on the confirmation page prior to closing the window.

Multiple entries are acceptable and can be submitted anytime during the month. Submission of request does not automatically generate or guarantee payment. All entries will be assessed prior to payment. A check will be sent to the Participant at the agency mailing address in our system around the 20th of the following month and only if the Bonus Bucks requests have been approved. Security First reserves the right to cancel the Bonus Bucks Program at any time. Bonus Bucks are non-transferrable.

IRS Regulations require Security First Insurance Company to issue a 1099 to any person who receives over $600 in any calendar year. This will require SFIC to obtain your social security number when your bonus meets or exceeds that amount.