Partner With Us – agentschoicefin

Thank you in advance for your time, and for giving AGENT’S CHOICE Premium Finance the opportunity to partner with you!

Please have your Agency State License, Producer State License, W9, and E&O documents available for upload. Additionally, we will require two market references.

This process should take less than 5 minutes to complete.

Email(A confirmation e-mail will be sent to this address.)

How Did You Hear About Us?

Primary Contact Phone Number

We use the above first name and last name to create a user name in our system. Will you require additional users to be setup for quoting?

Yes No

Agency Name (Full Legal Name.)

Agency Physical Street Address

Years in Business

<2 2-5 5-10 >10

Number of Employees

Estimated Total Annual Premium

Estimated Annual Finance Volume

What percentage of your business is commercial?

Estimated Number of Contracts

Class of Business/Specializations (Click all that apply)

Current Finance Vendor (Click all that apply.)

Agency Management System Information

What Agency Management System are you currently using?

Would you like to automate premium finance agreements from within your own agency management system?

Yes No

Electronic Notice Selection

By clicking here, you understand that you OPT IN to receive electronic notices from AGENT'S CHOICE PREMIUM FINANCE. You Knowingly and voluntarily give up and waive all rights to receive written notices delivered by A.C.P.F Mail and agreethat receipt of said notices delivered by electronic transmission satisfies any legal notice requirements. consent to receive electronic may be withdrawn in writing at anytime. By clicking here, you understand that you OPT OUT of receiving electronic notices. You will only receive notices from AGENT'S CHOICE PREMIUM FINANCE in written from delivered Via U.S. mail.

Market References

Please provide two market references, they will be verified prior to funding.

Market Reference 1 - Insurance Company or General Agent

Market Reference 2 - Insurance Company or General Agent

Required Forms and Documentation

Please upload your Agency State License

Please upload your Producer State License

Please upload your Agency W-9

Please upload your Errors & Omissions Document

Do you need to upload an additional document?

MANY THANKS FOR YOUR INTEREST, PLEASE CLICK ON SUBMIT BUTTON FOR SUBMISSION OF THE DETAILS, SOON WILL RECEIVE A MAIL FROM US.

AGENCY REGISTRATION

This process should take less than 5 minutes to complete.

Agency Information

Agency Management System Information

Electronic Notice Selection

Market References

Please provide two market references, they will be verified prior to funding.

Required Forms and Documentation

HEAD OFFICE

SITE LINKS

MAILING ADDRESS

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