Please review the agency agreements listed below. If you agree to the terms and conditions of each, please complete the following documents and e-mail them to firstname.lastname@example.org or fax them to (415) 373-0786.
- Agency agreement (select below)
- W-9 Form
- Current health insurance license
- Current E&O insurance coverage
Some carriers offer the ability to start writing business immediately by using an online contracting system.
|GeoBlue Broker Contract|
|IMG Broker Contract (PDF)
Link to online agency contracting site
|PIU Broker Contract (PDF)|
|HCCMIS Broker Contract (PDF)|
|Seven Corners Broker Contract (PDF)|
|W-9 form (PDF) – Required to be submitted with all contracts|
Please note that ITG Worldwide offers plans from other carriers who do not require an agency agreement. If you need any assistance or have questions as to which carrier would be best suited for your clients needs, please contact us.