Insurance Agency Agreement- Please downloads the following application:
In order to be appointed, the following items need to be returned to Patriot Underwriting for Processing:
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Fully executed Insurance Agency Agreement;
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Copy of your current agency license for you home state along with a copy of your personal license for those states that only require personal licenses. For surplus lines business, the requisite surplus lines license needs to be sent.
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Completed W-9 form ( see attached)
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A copy of your current E & O declaration page.
Please either
e-mail or
fax these items to Patriot and we will process accordingly.