Thank you for requesting to work with Resource Brokerage for those selected carrier(s). Please complete the fields below, so that we can get to know you.
Are commissions payable to you (SS#) or to an agency (FEIN)?
If paid to agency, please enter the agency NPN below.
Please provide your email if blank, and "Submit" form. Thank You
Note: After clicking “Submit,” you will be redirected to Resource Brokerage’s Contracting webpage, and your request will be submitted to our contracting department for processing. Please understand we may need to reach out to you for more information. Finally, please feel free to request additional lines or carriers.