Submit An Agreement

Please read the following Brokerage Agreement and fill out all Agency information fields below. Sign with your mouse or touch (if mobile), fill in your Contact information, upload your Agency E&O Dec and Agency License, and click Submit. All fields must be completed. A fully executed SBS LLC Brokerage Agreement will be emailed to you.

WITNESSETH

For the term of this Agreement, Specialty Brokerage hereby appoints Producer, subject to the terms and conditions set forth herein, without exclusive territorial rights, and subject to restrictions placed upon the Producer by the laws of the state or states in which Producer is authorized to write insurance. Specialty Brokerage markets insurance programs through various insurance providers. In any transaction or business arising under this Brokerage Agreement, Specialty Brokerage shall have the legal status of agent for the insurance providers and Producer shall have the legal status of broker representing the insured.

Term of Brokerage Agreement
MM slash DD slash YYYY
until terminated as provided herein

Signed for Specialty Brokerage:

By:

Printed Name: Patricia A. Curnutte

Title: President and CEO

Signed for the Producer:

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