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Agent Signup Application

Download Application

The following items must be completed and attached to your application

  • Agency Information Form
  • Completed and Signed Contracts (two originals)
  • W-9 Form
  • Copy of current Local Recording License (Property & Casualty)
  • Zerox copy of Drivers License (Carrier mandated)
  • Copy of E&O Policy (minimum coverage $1,000,000)
  • Hartford Addendum
  • E-Mail Address Addendum
  • PayExpress Authorization Form (Optional)
  • American Fidelity Application (TX Only / Optional)

Please mail the documents to: The Combined Group
Attention: Marketing Department
P O Box 819045
Dallas, Texas  75381-9045