Insurance Carrier Application

The INA looks to partner with Carriers, Wholesalers, and Program Administrators seeking distribution with our Networks. Carrier applications require Board approval. A one-time application fee $1500 will be invoiced at the time of application acceptance. Membership renews annually. Membership dues do not include registration fees for events. Membership dues are non-refundable.

You can expect to be contacted within 2-3 business days of submitting your application.

Insurance Carrier Application

Name of Company

Street Address

Address 2

City/Town

State

Postal Code

Company Website

Phone

Current A.M. Best Rating

Please list names, telephone numbers, and emails of those company representatives most likely to participate in carrier activities

Please list Networks contracted with

States Operated In

Categories you underwrite

If Other, specify here

Primary Contact

First Name

Last Name

The email address and password entered below will be used for your website account login.

Phone

User Account Password

Confirm Password