Skip to content

Become A Producer
GigBOP
Truckers CGL
Workers’ Comp
Find An Agent
Make a Payment
File A Claim
Contact Us

<img class="header-image is-logo-image" alt="Insurance for Small Businesses and the Gig Economy" src="https://synchronosure.com/wp-content/uploads/2020/09/synchronosure_blue_trans_logo.png" title="Insurance for Small Businesses and the Gig Economy" srcset="https://synchronosure.com/wp-content/uploads/2020/09/synchronosure_blue_trans_logo.png 1x, https://synchronosure.com/wp-content/uploads/2020/09/synchronosure_blue_trans_logo.png 2x" width="700" height="70" />

About Us
Products & Services
Producers
- Producer Login
Customers
Insurance-As-A-Service® Resources
- COVID-19 Reopening Guide for Businesses
- SynchronoSure® Resource Center
Insurance Partners

Producer Profile Registration

Producer Profile Registration Form

Tell us about your company. Your information is safe with us. We will not share or sell this to any third party. Fields with asterisk (*) are required.

Date
Date Format: MM slash DD slash YYYY
Producer Firm Name*
Producer Website
Producer Type*
FEIN Tax ID (Format: 00-0000000)*
National Producer Number (NIPR)*
Do you warrant that you carry surplus lines license?
- Yes
- No
Principal Information
Principal Name*
Email*
Ownership %
Add more Principal?
- Yes
Principal Name
Email
Ownership %
Principal Name
Email
Ownership %
Principal Name
Email
Ownership %
Contact Information
Physical Street Address*
Street Address Address Line 2 City State ZIP Code
Different Mailing Address?
- Yes
Mailing Address
Street Address Address Line 2 City State ZIP Code
Producer Main Phone*
Company Fax
Email – General Office
Email – Daily Billing Activity Files
Email – Policy Document Delivery
Email – Commission Statements
Email – Producer Experience Reports
Contract Contact
Contract Contact Name*
Contract Contact Phone*
Contract Contact Email*
Office Locations
Main Office Contact or Manager*
Number of Producers
Number of CSRs
Is the Physical Address also the Main Office Address*
- YES
- NO
Main Office Location
Street Address Address Line 2 City State ZIP Code
Add more office locations?
- Yes
You may also upload here an Excel (xls) sheet of all office locations
Name of Office Contact or Manager
Number of Producers
Number of CSRs
Location
Street Address Address Line 2 City State ZIP Code
Name of Office Contact or Manager
Number of Producers
Number of CSRs
Location
Street Address Address Line 2 City State ZIP Code
Name of Office Contact or Manager
Number of Producers
Number of CSRs
Location
Street Address Address Line 2 City State ZIP Code
Name of Office Contact or Manager
Number of Producers
Number of CSRs
Location
Street Address Address Line 2 City State ZIP Code
Name of Office Contact or Manager
Number of Producers
Number of CSRs
Location
Street Address Address Line 2 City State ZIP Code
Appointed States
Resident State to be Appointed*
Additional State for Appointment
Minimum Insurance Requirements
Errors & Omissions (E&O) Carrier*
Errors & Omissions (E&O) Limits (Minimum $1 million)*
Fidelity, Crime, Employee Dishonesty*
- Yes
- No
Insurance Carrier
Insurance Limit
Disciplinary Actions and Litigations
Has any member of your firm received any disciplinary action by a state insurance department or other regulatory authority?*
If YES, please explain
Is there any pending or threatened litigation or judgements within the past three (3) years against the agency or its employees?*
If YES, please explain
Is there any pending E&O claims within the last three (3) years?*
If YES, please explain
Do you maintain current resident licensure and non-resident licensure for all your producers?*
Total Premium Production
Commercial Premium Volume*
BOP Premium Volume*
Total Producer Volume*
List of 3 Largest Commercial Lines Carriers
Company Name
Company Name
Company Name
Terminated Companies in the last Three Years
Had your carrier cancel their appointment in the last 3 years?
- Yes
- No
Company Name
Reason for Termination
Company Name
Reason for Termination
Company Name
Reason for Termination
——————————————————————————————–
Upon agreement by both parties to proceed, the producer will be asked to submit the following documents:
- Sample Producer Agreement – (Download here)
- For Pennsylvania Producers, PA appointments require the PA Agency license as well as all PA Individual producer license(s)
Type Your Name*

Save and Continue Later

Visit the Insurance-As-A-Service® Resources page for access at your fingertips a suite of value added resources for legal, human resource management, risk management, mental health, ergonomics and loss mitigation services.

About Us

MORE. BETTER. GREAT.

Synchrono Group Inc., dba SynchronoSure®, is a state-of-the-art, digital underwriting and professional services business, intentionally built to leverage the convergence of technology and insurance through applications of proprietary artificial intelligence and predictive analytics capabilities, combined with recognized expertise in insurance and reinsurance industries.

Navigation

About Us
Products & Services
Producers
- Become A Producer
Customers
Insurance-As-A-Service® Resources
- COVID-19 Reopening Guide for Businesses
- SynchronoSure® Resource Center
Insurance Partners

Recent Posts

Sutton partners with SynchronoSure for gig economy and truckers cover
SynchronoSure® And Sutton Specialty Insurance Announce Partnership For Property and Casualty Products For The Gig Economy And Truckers GL
SynchronoSure® and American European expand their partnership to include Trucker General Liability for small trucking firms
Synchrono Group Inc. Selects CodeEast Digital Insurance Platform
SynchronoSure® supports #aDayforDemocracy

Our Offices

United States
8521 Six Forks Road, Suite 105,
Raleigh NC 27615, United States

Philippines
28th Floor Tower 2, The Enterprise Centre,
6766 Ayala Ave., Makati City,
Metro Manila, Philippines 1226

Contact Us

Phone: 888 389 0439

Email:

marketing@synchronogroup.com
techsupport@synchronogroup.com
customersupport@synchronogroup.com

Terms of Service | Privacy Policy | California Rights & Disclosures | Sitemap

© 2021 Synchrono Group, Inc dba SynchronoSure® | Insurance-As-A-Service

Skip to content

Accessibility Tools

Increase Text
Decrease Text
Grayscale
High Contrast
Negative Contrast
Light Background
Links Underline
Readable Font
Reset

Sitemap
Contact Us