Thank you for your interest in doing business with South Texas General Insurance Agency. To become appointed with STGIA, you must have a valid Texas Insurance License and current Errors and Omissions. We currently have no volume commitments and welcome submissions from all valid Texas licensed producers. Please complete the Agency Information Form below. Note: If you are signing up under a business name, that entity must be licensed with the Texas Department of Insurance; otherwise you must sign the agreement in your personal name. For additional information regarding South Texas General Insurance Agency and/or the appointment process, please contact our Marketing Department at 281.820.0555/800.873.6500 or email floring@stgia.com.



AGENCY INFORMATION

Name:

Home Address:

City: State: Zip:

Agency Name:

Agency Street Address:

Agency Mailing Address:

City: State: Zip:

Telephone: Fax: Email:

Website:

GENERAL INFORMATION

The Agency is:

When was agency established? Number of Employees:

List Owners, Partners, or Corporate Officers:

Title:

Title:

Title:

Companies you are presently representing:

Standard

Surplus

How did you hear about South Texas General Insurance Agency?

What percentage of your total agency volume is:

Personal Lines: Commercial Lines:

I am interested in: Personal Commercial Both

In addition to insurance sales, does the applicant regularly engage in any other business pursuits?

Yes No

If "yes", please explain.

PRINCIPAL / LICENSE INFORMATION

Federal Tax #: Social Security #:

Do you have E & O?  

Name Listed on License:

Recording Agents License Number:

FAIR CREDIT REPORTING ACT NOTICE: This notice is given in compliance with the Federal Credit Reporting Act (Public Law 91-508). As part of our underwriting procedure a routine inquiry may be made which will provide applicable information concerning character, general reputation, and personal characteristics. Upon written request, additional information as to the nature and scope of the report, if one is made, will be provided.

Agent Initials

Upon submitting your Agency Information Form, an Agency Agreement will be mailed to you. The following documents should be returned including:

  • The owner/principal of the agency should review and sign the Agency Agreement (sign and return both copies)
  • Copy of your Errors and Omissions Declarations Page
  • Copy of General Lines Agent License for Property & Casualty
  • Agency Appointment, Termination & Licensing Request Transmittal (will be enclosed in your packet)

Thank you for your interest in South Texas General Insurance Agency. We look forward to doing business with you and your agency!


© 2010 South Texas General Insurance Agency.