IAP Company Appointment Request Form

Please select the (personal lines) of insurance types below that you offer or wish to offer:*
Please select the (commercial lines) of insurance types below that you offer or wish to offer:*
Are you interested in offering premium finance options to your clients?*
Are you the Agency Principal?
# of Licensed Producers:*
# of Dedicated support staff and CSR's:*
Agency Legal Status*
Please select lines you are seeking appointments for:*
Number of Agency Customers:*
Total Agency Premium Volume:*
Percentage of Personal Lines vs Commercial Lines:*
Please select your premium commitment level you will have:*
Do you have Errors and Omissions coverage with at least $1,000,000 limits?*
Have you ever had any Errors and Omissions Claims or Losses?*
Do you currently have Errors and Omissions Insurance?*
Would you accept an appointment from a company that has a yearly premium commitment?*
Please note: This will not disqualify you from gaining carrier appointments.
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Thank you for completing the onboarding for your Agency Appointments. We will review this and get back to you with your agency appointment

We look forward to assisting you in getting you set up with the companies that are a good match for your agency. Once you have filled out and submitted this form we may be in touch to gather additional information. There are a few additional items we will need from you that are listed below along with directions.

1) Please email the declaration page of your Errors and Ommissions insurance to: [email protected]

2) In the subject line please list the name of your Agency and First and Last Name.