Become An Agent

Please note we are not accepting new agency appointments in Central and Southern Florida at this time.
For all other submissions, three year loss runs from at least 3 Florida homeowners carriers will be requested once you submit the online form. If you are not able to provide loss runs, your application will not be considered at this time.

Become an Agent

Corporate Name

DBA/Agency Name

Street Address

City

State

Zip Code

Primary Contact Name

Email Address

Phone

Fax

Website

Tax ID Number

Date Agency or Location Established

Agency Book of Business Percentage(s) – Please indicate the percentage of your book of business in the following lines

Homeowners/Dwelling %

Mobile Homes %

Auto %

Commercial %

Life/Health

Other %

What is the average number of HO/DP Policies written per month?

What is the average number of Mobile Home Policies written per month?

Is there an opportunity for a rollover

Yes

If yes. from which carrier

Agency Production - Please list your five largest personal lines carriers in order of volume

Carrier 1

Carrier 1 Name

Carrier 1 Premium

Carrier 1 Commission %

Carrier 1 Date Appointed

Carrier 1 Loss Ratio

Carrier 2

Carrier 2 Name

Carrier 2 Premium

Carrier 2 Commission %

Carrier 2 Date Appointed

Carrier 2 Loss Ratio

Carrier 3

Carrier 3 Name

Carrier 3 Premium

Carrier 3 Commission %

Carrier 3 Date Appointed

Carrier 3 Loss Ratio

Carrier 4

Carrier 4 Name

Carrier 4 Premium

Carrier 4 Commission %

Carrier 4 Date Appointed

Carrier 4 Loss Ratio

Become An Agent

Become an Agent

Agency Book of Business Percentage(s) – Please indicate the percentage of your book of business in the following lines

Agency Production - Please list your five largest personal lines carriers in order of volume

Carrier 1

Carrier 2

Carrier 3

Carrier 4

Thank you for your interest in our company(s). Our Marketing team will review this information and be in contact within 7 business days.

Products

Policyholders

Quick Link