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Agency Application

Thank you for your interest in Independent Market Solutions!

Before you begin the application, please make sure you have quick access to the following, which you’ll need to complete the process:

  • Agency (if applicable to your state) and individual agent license numbers
  • Agency Federal Employee ID Number (FEIN)
  • Agency E&O policy information
  • Premium count information
  • Premium volume information

Applications must be submitted separately for agencies that have branches with separate FEINs.

Indicate State Being Applied For
Agency Legal Name* 
Agency DBA Name (if applicable)
Physical Address* 
Mailing Address* 
Federal Employee ID No. (FEIN)* 
Type of Entity*  
Agency Website
Agency License No.* 
Agency Principal 1*         

Agency Principal 2 Agency Management System* 
Additional Agents To Be AppointedNumber of Agents You Would Like To Appoint:
First NameLast NameAgent License No.
No. of Agents on Staff* 
No. of CSRs on Staff* 
No. of Employees* 
No. of Years In Business* 
Contact Person*       

Contact Phone* 
Contact Email*   
Have you or anyone listed on this application ever pled guilty or nolo contendere to or been convicted of a felony crime in any state or federal court? Any license suspensions in the last five (5) years? Has any carrier terminated the agency in the past three (3) years for production and/or adverse loss ratio? Other business (e.g. real estate) conducted from premises?

E & O Information

E&O Carrier* 
Policy No.* 
E&O Limit* 
Expiration Date (mm/dd/yyyy)*  
Any judgements or suits agains the agency?:

Agency Premium Volumes

Homeowners Revenue* 
Dwelling Fire Revenue* 
Flood Revenue* 
Personal Auto Revenue
Commercial Revenue
Total Property & Casualty Revenues
Total No. of Personal Accounts* 
Total No. of Commercial Accounts* 

Three Largest Homeowners Markets

Carrier Policy Count Premium Volume ($)
     
No. of new homeowners policies written per month:
Personal Lines pure loss ratio:

Three Largest Commercial Markets (if applicable)

Carrier Policy Count Premium Volume ($)

ATTENTION: Please choose a state under "General Information" for which you are applying for market access to.

FAIA/IMS wants to help your agency with access to markets. However, FAIA / IMS cannot guarantee market access to every FAIA member agency. Each insurance company has complete control over the approval of each individual subproducer. Agency appointments are made to compliment and not conflict with direct appointment agencies. Appointments are based on mutually beneficial and profitable relationships, and no appointments are guaranteed.

Please note: FAIA Member Services’ property markets program is in the process of moving over to the IMS platform. Look for additional carriers in the future; in the meantime, visit FMS online for more information about property markets.

IIABL/IMS wants to help your agency with access to markets. However, IIABL / IMS cannot guarantee market access to every IIABL member agency. Each insurance company has complete control over the approval of each individual subproducer. Agency appointments are made to compliment and not conflict with direct appointment agencies. Appointments are based on mutually beneficial and profitable relationships, and no appointments are guaranteed.

Please select the insurance companies your agency would like to apply for market access through IMS (check all that apply)

If you have you previously been appointed or worked for an agency appointed with one of the IMS carriers, please specify which one(s):

Please provide the following documents specified below. Documents must be either .jpg, .jpeg, or .pdf and cannot exceed a file size of 2MB

Please upload your E&O Policy Declarations Document.
 
 

Please upload your Agency License.
 
 

Please upload your Individual Agent License.
 
 

Your state association will confirm that your agency is a member in good standing, after which your information will be shared with the carriers requested. Please allow 14 business days for processing and notification of sub-appointment.

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