Developing a relationship with Mid Atlantic Insurance Services, Inc. will be the most rewarding thing you do for your business this year! What do we need from you? Just a few things:
 

• Fill out our broker agreement.(click here to download)
• Fill out our direct deposit form.(click here to download)
• Fill out a tax form.(click here to download)
• Provide a copy of Errors and Omissions insurance declarations page(s).
• Copy of agency license
• Copy of all state licenses
• Copy of agent licenses that work for your company

Please fax the above information to “New Agent Appointment” at 804-377-1169. Please note: policy coverage cannot be bound until we have the above information.

Submission Requirements (from current site)

Please FAX complete submission applications to 804-377-1169 or

Please EMAIL complete submission applications to quotes@midatlanticins.com

Submission applications must include:

• Complete Acord applications, with full description of operations. Please provide additional information in “remarks” areas of Acord applications for questions answered “yes”.
• Three years loss runs or a signed no loss letter on company letterhead, depending on the type of risk.
• Copy of NCCI report if applicable.
• Supplemental applications if required, depending on the type of risk.