Apply to become a broker

Sample Producer Agreement      W-9
Step 1 of 6

Agency Registration Directions

Before you start, we thought it would be helpful to provide you with an overview of the items
you will need to complete the appointment registration process:

  • Name and contact information for the agency manager/principal.
  • Firm information, including tax ID, primary address, year established,a copy of your Agency License Number, and officers and list of principals.
  • Copy of your current Errors and Omissions policy
  • Completed W-9 form (copy of a W9 form found at registration homepage)
  • Copy of your 220 agent license

Once the information is submitted electronically, CIU will review the appointment request and advise on approval, responding
to the email address provided during registration. Once approval is received, you will need to set up any additional agents within
your agency needing access to the online application. This can be done simply by –

  • Logging into the online application and selecting Edit Agency/Broker.
  • On the Agency Information page, select the Users tab.
  • Select Add User and then provide the following information for each agent user needing system access:
        email address, license number, first and last name, phone number and password.
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