Ready to become a Partner?

Becoming a partner with Bankers Insurance Group gives you access to a family of business with over 45 years of experience, a dedicated on-site service team, an extensive portfolio of products and services, and a partner that will be there when it matters.

Bankers Insurance Group & Advantage Partner Questionnaire

Ready to begin your partnership with Bankers via Advantage Partners? Complete the questionnaire below to get started.

Agency Name (Legal Business Name):*

Agency DBA Name (If applicable):

Mailing Address*
Street Address Address Line 2 City State ZIP Code
Physical Address*
Street Address Address Line 2 City State ZIP Code

Telephone #:*

Fax #:

Location is a Sub-Office for:

Agent ID #:

Commission statements to:*

Main Office

Commission check to:*

Main Office

Email*

Agency communications email address (Product communication, Binding notices, Master password reset, etc.)

Agent's Licensing Information

License #:*

License Type:*

Current Personal Address*
Street Address Address Line 2 City State ZIP Code

County:*

Email*

Agency Document Delivery Method

1. Please email agent copies in ONE of the following:*

By individual policy number
By transaction day

2. Email address to receive electronic files (only one address may be listed)*

Signed Copy Consent*

Sub-Agent agrees to keep a signed copy of the application on file for 7 years*

Idemnification Consent*

Sub-Agent warrants and agrees that is has executed a Retail Brokerage Agreement, or a document containing indemnification and hold harmless language in favor of Advantage Partners, with Advantage Partners*

Comments
This field is for validation purposes and should be left unchanged.

Ready to become a Partner?

Bankers Insurance Group & Advantage Partner Questionnaire

Agent's Licensing Information

Agency Document Delivery Method