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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*

Phone #*

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)

Please choose programs you are interested:

.

Amtrust

Associated Mutual

Attune

Blitz

BTIS

Coterie

ERGO I Next

.

Foxquilt

MGT

National General

Pathpoint

Pie Insurance

Propeller

Rainbow

.

Root

Simply Insurance

Slice

Steadily

Stillwater

Swiftt

Three

Licensed agent name*

Title*

Signature*

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Date*

Signed Brokerage Agreement*

Agency License*

Agent License*

W9*

E&O dec page or COI*

E&O Expiration Date*

Month

Day

Year

Brokers Agreement Download

ABOUT

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NEW AGE UNDERWRITERS AGENCY, INC.

dba NAU Alliance Insurance Solutions

1 Old Country Road Suite 421

Carle Place, NY 11514

(516) 488-2500

CA Lic#6016974

NPN# 8231535

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NEW AGE UNDERWRITERS AGENCY, INC.

Brokers Agreement

ABOUT

HELP

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