Click “browse” to select the file you’d like to upload and then click “upload.” Only PNG, PDF, JPEG, TIFF files are supported.
Your file has been successfully uploaded when you see “View/Remove” in each section.
You can verify that you’ve uploaded the correct document by clicking “View.”
Uploaded the wrong file? No worries, simply click “remove” and browse for a new file.
*- Required Fields
Upload copy of your E&O (Certificate of Liability Insurance):
If commissions are paid to an agency, all information on W-9 must be agency information only.
If commissions are paid to an individual, all information on W-9 must be individual’s information only.
Licensed in the State of:
License # for the State:
Upload copy of License:
Thank you for completing the requirements. Your credentials are currently being verified.
Our Credentialing Department is currently verifying the validity of your documentation.
The process takes about 5 to 7 business days.
A representative will contact you if additional documentation is needed.
You will receive a Welcome Packet with an email confirmation, and
One of our Account Executives will contact you.
If you have any questions, please call us at 1.877.760.2247