Get New Agent/broker Application R Eferences & Authorization Agency ...

Filling out the New Agent/Broker Application is a vital step in the onboarding process for new agencies. This guide provides clear, step-by-step instructions tailored to help users complete the form accurately and efficiently online.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred online form editor.
2. Begin by entering the date and the name of the person completing the application in the designated fields. Ensure all information is accurate.
3. Fill in the agent or broker’s legal name and any applicable Doing Business As (DBA) name. Provide the Federal Employer Identification Number (FEIN) and license number as required.
4. Complete the agency's contact information, including the physical address, city, state, zip code, phone number, and fax number.
5. Input the principal name of the agent or broker, along with their contact details, including phone number and email address.
6. If applicable, provide the name and contact details of any additional agent/broker contact, along with their title.
7. State the years your agency has been in business, the total number of employees, and the number of producers associated with the agency.
8. Estimate the premium volume, premium finance volume, average account size, and the number of financed accounts your agency manages.
9. List the types of business your agency conducts and current premium finance sources.
10. Express your reasoning for partnering with FIRST by filling in the details under ‘What brings you to FIRST?’
11. Document any endorsements or affiliations your agency has, such as Assurex or MarshBerry, and specify integration platforms used.
12. Provide details for three carrier/general agent references and one bank reference, including contact names and phone numbers.
13. Indicate signatory authority regarding premium finance agreement representations, ensuring to clarify who may sign.
14. Review all the information provided to ensure accuracy. Finally, sign and date the application in the specified fields.
15. Once you have completed filling out the form, save your changes. You can also download, print, or share the completed document as required.

Complete your New Agent/Broker Application online today to begin your journey with FIRST Insurance Funding Corp.