producerinfo

U. S. Risk
Marketing Department
10210 N. Central Expressway, Suite 500, Dallas, Texas 75231
Phone: 800-232-5830
Fax: 214-265-4976

Download Producer Profile and Agreement in Word format
Please note: This document can be filled in online, the W-9 must be downloaded below
or
Download Producer Profile and Agreement in Adobe Acrobat format
Please note: This document is intended to be filled in by hand and includes the W-9 form

Download W-9 form here in Adobe Acrobat format
Please note: This form is required with your Producer Package -

Fax completed paperwork to 214.265.4976 (Attention: Marketing)

Thank you for your interest in doing business with U. S. Risk. To be considered for an appointment, the following should be completed:

1. Complete the attached Producer Profile (in its entirety).

2. The owner/principal of the agency needs to review and sign the Producer Agreement (attached). All four (4) pages of the Agreement should be returned with the other paperwork mentioned here.

3. Complete and return W-9 form (form available above).

4. Copy of your current agency license for your home state and your surplus lines license if applicable. Note: If your State only licenses the individual, please send a copy of this.

5. Copy of current E & O and E & O umbrella declarations page (if applicable).

Please fax all of the above mentioned documents together. Any document(s) not completed will delay the approval process and be returned to your agency.

Return all documents (including all 4 pages of the Agreement) to fax number 214-265-4976.

For more information on our programs or appointments, please contact Evan Ryan in the Dallas
office at 1-800-232-5830 for assistance.

There is no need to mail the hardcopy paperwork - please keep this in your permanent files.

We look forward to working with you.

Thank you.