Existing Companies- Required Information

New Companies- Required information

• Acord 130 Application - (Form Fillable)

• Last 3 years loss runs from current carrier

• Current experience mod (if applicable)

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• A Work Comp Affidavit - (Form Fillable)    *acceptable for some risks in lieu of Loss Runs

Our Fax:  888.583.3110

Our E-mail:  submissions@insuranceshopllc.com

• Acord 130 Application - (Form Fillable)

• Work Comp Loss Affidavit - (Form Fillable)

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• Owner Resume may be required

We provide numerous ways to work with our agency to best serve your needs and your clients needs:

• Provide us with the information we need and we will provide quotes directly to you

• Have your clients and prospects contact us directly at 888.611.SHOP (7467)

• Complete our Lead Referral Form and we will do the rest

• Have you clients submit their information to us online

• e-mail your client's contact information to us at submissions@insuranceshopllc.com