top of page
Home
Products
Wholesale
Specialty Lines
Aggregator
Contact
Aggregator Log-in
Brokers Agreement
NEW AGE UNDERWRITERS AGENCY, INC.
Brokers Agreement
Thank you for your interest in placing business with our company. Kindly fill out the following:
Legal Agency Name
*
DBA
*
Address
*
City
*
State
*
Zip code
*
Email
*
Secondary Email
Website
Years in Business
Total Agency Volume
% of Commercial Lines
% of Personal Lines
Number of office locations
Number of Employees
States Licensed
Agency NPN
*
Agent NPN
*
Top 5 Carriers
NIche Target/Market's
Affiliated with any other Aggregator or Cluster Group? (if yes, name)
Multi choice
Amtrust
Associated Mutual
Attune
Blitz
BTIS
Coterie
ERGO I Next
Multi choice
Foxquilt
MGT
National General
Pathpoint
Pie Insurance
Propeller
Rainbow
Multi choice
Root
Simply Insurance
Slice
Steadily
Stillwater
Swiftt
Three
Licensed agent name
*
Title
*
Signature
*
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Date
*
Signed Brokerage Agreement
*
Upload File
Agency License
*
Upload File
Agent License
*
Upload File
E&O dec page or COI
*
Upload File
E&O Expiration Date
*
Month
Day
Year
Submit
Brokers Agreement Download
bottom of page
