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)
• E-Mail Address Addendum
• PayExpress Authorization Form (Optional)
• American Fidelity Application (TX Only / Optional)

Please send the documents to:  

newagent@combinedgroup.com

or

Fax to:  800-275-3194  Attn:  New Agent Appointment