Thursday, January 16, 2025
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Sample Producer Agreement
W-9
Agency Registration Directions
Before you start, we thought it would be helpful to provide you with an overview of the items
you will need to complete the appointment registration process:
1. Name and contact information for the agency manager/principal.
2. Firm information, including tax ID, primary address, year established, and officers and list of principals.
3. Copy of your current Errors and Omissions policy
4. Completed W-9 form (copy of a W9 form found at registration homepage)
5. Copy of your 220 agent license
6. Copy of your entity license
Once the information is submitted electronically, we will review the appointment request and advise on approval, responding
to the email address provided during registration. Once approval is received, you will need to set up any additional agents within
your agency needing access to the online application. This can be done simply by –
1. Logging into the online application and selecting
My Agency
.
2. On the Agency Information page, select the
Users
tab.
3. Select
Add New
and then provide the following information for each agent user needing system access:
email address, license number, first and last name, phone number and password.
Add Agency (entity) State License Number
State
Agency (entity) License Number
License
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