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Agency Details

To complete the Agency Producer Agreement including Exhibits A & B, enter the required information in the Agency Detail section by typing data into each field then pressing the tab key to move to the next field. Once completed add the Agency location(s), Producer(s), Customer Service Representatives and Agency officers.
Mailing Address
Physical Address
Agency Name Address 1   Address 1
dba Address 2   Address 2
FEIN City   City
Phone Number State    Zip   State  Zip
Agency License
Agent-In-Charge
Agency Principal  
 
Principal's Email            

Agency Location Exhibit A (One location per Line)

To add the Agency Locations(s) click Add location button. Enter required information in the fields then click save. Repeat for additional Agency Locations.

Designated Producers at Agency Location:

To add Agency Producer(s) click Add Producer button.  Enter required information in the fields then click save.  Repeat for additional Producers. Note: For Agencies with more than one location select the correct Producer Assigned location for each Producer.

Customer Service Representatives:

To add the Customer Service Representative click the add CSR button. Enter required information in the fields then click save.  Note: For Agencies with more than one location select the correct CSR location for each CSR.

Agency Officers, Senior Managers, Directors, Partners and Controlling Persons:

To add Agency Officers, Senior Managers, Directors click the Add officer button. Fill in the required fields. Repeat for additional officers.



Once completed, click print button.  Click open when prompted, review the Agreement and Exhibits then print and secure signatures of the Authorized Agency Principal and each Designated Producer then email to agency@fwcjua.com

 
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