Welcome Agents and Brokers !
Welcome Brokers and Agents!

If you are an Insurance Broker or Agent and not already registered with us, please fill out the application form below and hit 'Submit'.

Permanent registration is subject to approval from Please note that eligibility for our Broker/Agent program requires the applicant to hold a valid Agent or Broker license and a valid Error and Omissions policy.

As soon as you're registered, we will email you an Agent/Broker ID number along with information on how to access the site using that number.

For more information on our Agents and Brokers program, please contact us:
(phone) 1-866-889-4763 or (email)

Today's Date 03/24/2019
Contact Information and Agency Details
Professional Liability Errors & Omissions Coverage
Insurance Brokerage Licenses
Please specify the insurance license number for each State in which you are licensed to sell/broker insurance. (Leave blank, or indicate with N/A, the entry for any State in which you are not currently licensed)
Alabama Alaska
American Samoa Arizona
Arkansas California
Colorado Connecticut
Delaware District Of Columbia
Federated States Of Micronesia Florida
Georgia Guam
Hawaii Idaho
Illinois Indiana
Iowa Kansas
Kentucky Louisiana
Maine Marshall Islands
Maryland Massachusetts
Michigan Minnesota
Mississippi Missouri
Montana Nebraska
Nevada New Hampshire
New Jersey New Mexico
New York North Carolina
North Dakota Northern Mariana Islands
Ohio Oklahoma
Oregon Palau
Pennsylvania Puerto Rico
Rhode Island South Carolina
South Dakota Tennessee
Texas Utah
Vermont Virgin Islands
Virginia Washington
West Virginia Wisconsin
      (*'d fields are mandatory)
  • I am an Authorized Representative and/or an Officer of the licensed Brokerage.
    In addition, I confirm and warrant that the licenses described above are in good standing.
    I further confirm and warrant that the E&O policy described above is in full force and effect.
  •   YES