Insurance Agency Appointment Application

Agent let’s see if you are a fit, please tell us more about you!

Insurance Agent 2026 Form

Name of the person completing the form

First Name

Last Name

Title: Example President

Phone

2. Owner Information

First Name / Last Name of the owner

First Name

Last Name

Owner Phone Number

Extension

Owner email address

Additional owners, if any.

2. Agency Information

Agency Name

Agency Start Date

Agency license number

Agency Website/URL

Agency email address

Agency phone number

Agency Address

City

State/Province

Zip/Postal

Country

Additional locations, if any (optional):

3.

Number of employees

Number of customer service representatives

Number of full-time P+C producers

4. Professional Liability Insurance

Do you have Professional Liability Insurance?

Yes

Name of the insurance company

Policy term

Limits (Example:100,000)

5. Premiums

Total agency premiums: example 100,000

Any programs?

Are you a member of a clustor/aggregator?

YES

If yes, which one?

Total agency P+C when annually booked

Top 5 company placements for P+C

Top 5 wholesale placements for P+C

What products are you interested in placing with Colonial Surety Company and why?

Why are you interested?

What is the expected first year commitment? example 100,000

2nd year commitment? example 100,000

3rd year commitment? example 100,000

Do you prefer direct billing or agency billing?

Direct Billing

Agency Billing

5. Review

Terms of service: I have reviewed the above mentioned information and is in the best interest of my knowledge, and is accurate representation of my agency profile

Yes

Name

Title

Signature

Date

How did you hear about us?

If you are human, leave this field blank.

Why you should choose Colonial Surety Company

Instant & Flexible

We offer a streamlined purchase process that allows you to instantly purchase bonds and insurance online.

Reach

Licensed and admitted in all U.S. states and territories.

Rating

Rated “A” Excellent by A.M. Best Company and U.S. Treasury Listed.

Service

We provide live customer service. You will speak to a person when you call us.

Learn More About Colonial Surety Company

Get the word straight from our customers