If
you wish to have our agency take over the servicing of an existing
policy please copy and paste the letter below
to your company letterhead. If individual policies, please enter
your Name, Address, City, State and Zip. Please note to replace date
and
list insurance companies and policy numbers you wish to have us assume.
Once completed and signed, mail or fax the form to us as indicated
in our contact page.
(FOR
BUSINESS PLACE THE LETTER ON YOUR LETTER HEAD
--OR--
FOR INDIVIDUALS PLEASE ENTER
NAME
ADDRESS
CITY, STATE. ZIP)
(DATE)
RE: Appointment of Allied Insurance Centers as our Agent/Broker of Record
To Whom it May Concern:
This will confirm that we have appointed Allied Insurance Centers as our exclusive
insurance agent/broker of record for the following policies
The
appointment of Allied Insurance Centers rescinds all previous appointments
and the authority contained herein shall remain in force until
canceled by us in writing.
This letter also constitutes your authority to furnish Allied Insurance Centers’s
representative with all information they may request as it pertains to our
insurance contracts, rates, reserves, retention, and all other financial data
they may wish to obtain for their study of our present and future requirements
in connection with our insurance policies.
Sincerely,
(NAME)
(COMPANY / INDIVIDUAL NAME)
(TITLE, IF APPLICABLE)
Allied Insurance Centers
Brookfield 12750 W. North Avenue
Brookfield, WI 53005-4624
Note: As stated
in our "Terms of Service" (TOS) agreement,
descriptions of insurance coverage on this web site are for informational
purposes only and may not apply, or be included on your policy. Please
contact us to confirm coverage provided on your insurance policy or
policies your are contemplating purchasing.
