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Appointment Checklist

In order to become a producer with us, you must submit the following documents for approval:

  • Please complete and sign the attached Broker Profile & Brokerage Agreement

  • Provide us with a copy of your E&O Declarations page.

  • Provide a copy of your Agency License and certificate.

  • Provide us with copies of the state licenses for your agency staff.

  • A completed and signed W-9 form

  • ACH authorization – return premiums and commissions


You may fax or email the aforementioned documents to:

Fax: (904) 432-1124 



Please feel free to contact our office if you have any questions.

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