BECOME AN APPOINTED PRODUCER WITH EMPIRE STATE BROKERAGE SERVICES.

Recognizing and developing long-term relationships with our producers and our insurance companies is our main goal. This, coupled with the variety of specialty insurance companies we represent, makes us a unique outlet for your surplus lines business.

Request an Appointment

Prior to requesting an appointment, please download, print and complete the two forms listed below. You will need to include them with your request for appointment.

IRS Form W-9  Producer Agreement & Questionnaire

  • Agency Details

    Please upload agency details requested below.
  • Max. file size: 300 MB.
    Please upload a copy of evidence of your agency's in - force Insurance Agents E & O. A certificate of insurance will suffice. Our minimum requirements for E & O coverage is $1,000,000/$1,000,000.
  • Max. file size: 300 MB.
    Please upload a copy of your agency's P & C license for the state where your home office is domiciled.

  • Additional Forms

    Please upload the following completed forms (these forms can be downloaded from the appointment page on our website)
  • Max. file size: 300 MB.
    Please upload a completed IRS Form W-9.
  • Max. file size: 300 MB.
    Please upload a completed Producer Agreement and Questionnaire.
  • This field is for validation purposes and should be left unchanged.