Insurance License

Use the form below to request an insurance license. Don't hesitate to contact us with any questions. The insurance license applies to the following type of insurance agencies:

Life Insurance
Accident Insurance
Health Insurance
Accident and Health Insurance
Automobile Theft Insurance
Automobile Fire Insurance
Automobile Liability and Property
Damage Insurance
General Casualty Insurance
Marine Insurance.

License fees are due for renewal annually on June 1st unless otherwise specified. If the applicable fee is not paid during June, it becomes delinquent on July 1st. At which time a 10% penalty must be added to the base fee. An additional penalty of 1% per month will be added on the first day of August and each succeeding month until payment is received.

Insurance License Application

Business Name(Required)

Owner or Manger Name(Required)

Primary Contact Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Please upload a copy of your most recent property tax receipt.(Required)

Accepted file types: jpg, jpeg, heic, png, pdf, Max. file size: 50 MB.

Please upload a copy of your most recent fire inspection report.(Required)

Accepted file types: jpg, jpeg, heic, png, pdf, Max. file size: 50 MB.

Agent Name

License Fee(Required)

The license fee is $55.00 for the agency and $30.00 for each additional agent. License fees are due for renewal annually on June 1st unless otherwise specified. If the applicable fee is not paid during June, it becomes delinquent on July 1st. At which time a 10% penalty must be added to the base fee. An additional penalty of 1% per month will be added on the first day of August and each succeeding month until payment is received.

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