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Agents, Adjusters & Brokers
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Premium Service Company
Application for Premium Service Company,
Every question on the application must be answered. Indicate "none" or "not applicable" if a question does not apply.
Articles of Incorporation or Certificate of Domestication
License fee of $1,000
Notice of Financing statement
sample Notice of Premium Financing
The applicant must have a net worth of at least $20,000 and personal assets are not accepted.
Premium Service Company Bond,
Under no circumstances will the $50,000 Security Bond or Certificate of Deposit requirement be waived.
The following items must be submitted in duplicate:
Premium Service Agreement
sample Premium Service Agreement
Maximum Rate Schedule (
Promulgated Maximum Schedule
Notice of overdue payment (Intent to Cancel)
Notice to insurer that policy is financed
Request for cancellation