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Producer Application
Your form was not submitted. Please correct errors below and re-try.
Agency Name:*
'DBA' or Assumed Business Name:
Address 1:*
Address 2:
City:*
State:*
Zip:*
Telephone:*
Fax
Email Address:*
Agency Website:
Year Agency was established:*
Tax ID or FEIN:
Principal and percent of ownership:
Principal and percent of ownership(2):
Principal and percent of ownership(3):
Commercial Lines Manager:
Years of experience:
Personal Lines Manager:
Years of experience:
Percentage written in agency:
Commercial Lines:
Personal Lines:
Benefits:
Please list all states that your agency is licensed to write business:*
Admitted or Standard companies companies that you represent:*
General Agents / Surplus Lines Brokers you write with:*
Total Agency Volume:
Total E&S Volume:
Does your agency have a niche or specialization?
Yes
No
If yes, please comment:
How did you hear about GSU?
Document Upload:
Copy of Agency License:*
Copy of E&O declaration page:*
Home
About Us
Associations
Company Bio
GSU History
Products
Commercial P&C
Garage
Personal Lines
Transportation
Policy Services
Online Payment
Premium Financing
Report a Claim
Request Loss Runs
Contact Us
Agency Updates
Directory
Get Started with GSU
Locations
Marketing
Privacy Notice
Request for Login
CA Consumer Privacy Act 2018 (CCPA)
Lloyd's CCPA Privacy Policy
Applications
Commercial P&C
Garage
Personal Lines
Transportation
News & Events
Career Opportunities
Claims
Online Payment