Resource Center Brokerage Agreement Forms & Applications Links Programs Placemat Brokerage Agreement Forms & Applications Links

Brokerage Agreement Marketing Materials Forms & Applications Links FOR QUESTIONS RELATING TO ANY WILLIS PROGRAMS PRODUCT, PLEASE USE THE FORM BELOW:

Contact Name:
Agency name:
State:
Phone #:
Email address:

Program(s) interested in:
AutoServiceGuard PlasticsGuard
CAR-PAC ThePUMPPrograms
DealerGuard RecycleGuard
EquipGuard ResortGuard
HealthServicesGuard RinkGuard
HoaPoaGuard ShredderGuard
HomeCareGuard SocialServicesGuard
LawyerGuard UtilitySure
LimousineGuard WasteHaulerGuard
MedEquipGuard WellGuard
MetalWorkingGuard WorkCompGuard
MountainGuard Freberg Environmental Insurance

How did you hear about Willis Programs?

Writing Business With Us

Writing Business With Us

Willis Programs offerings are available to insureds through independent insurance agents. If you are a broker or agent and wish to become approved to write business with us you will need to submit the appropriate documentation by mail or e-mail. In an instance where the same submission is received from more than one broker, a Broker of Record letter determines control.

▪ Proof of E&O showing a minimum of $1,000,000 limit per occurrence.
▪ Copies of your agency and individual producer licenses
▪ Complete W-9 Form.
▪ Completed Broker Profile


Click here to request a Brokerage Agreement

Click here to view a Sample Brokerage Agreement