1520 Sheridan Drive | Buffalo, NY 14217 | 716.874.1644 | 1.800.424.2202 | Fax: 716.874.4920

Become a Broker

FAX OR E-MAIL COMPLETED FORMS TO: (716) 874-4920

Rob Martin

Ext. 204

Marketing Manager, Producer Relations

Broker Agreement Packet - New York - fillable forms
Broker Agreement Packet - Pennsylvania - fillable forms
Broker Application - Commercial/Personal Lines - (Fillable PDF)
Broker Application - Motorcycle - (Fillable PDF)
Fax / E-mail Consent form