Producer
Questionnaire & Agreement
This
form will assist us in identifying your insurance needs as well
as knowing who the key contacts are in your office.
Please
attach evidence of Errors & Omissions Insurance Coverage and
a copy of your current agency license.
We,
like you, are an insurance intermediary and are bound by the credit
terms of the insurance carriers with whom we place risks on your
behalf. Balances are due on receipt of the invoice, unless the
issuing insurance company requires payment prior to binding, as
is the case with some Workers Compensation placements. We will
send an invoice at the time an account is bound and will also
send a statement at the end of the month.
