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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 |
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Attention: Marketing Department |
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P O Box 819045 |
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Dallas, Texas 75381-9045 |
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