Agent Sign Up

Becoming a producer with Specialty Insurance Services is easy!

      1.  Complete this form and click “Sign Up” at the bottom of the page.
      2. The email address you provide will receive our Agency Profile and Producer Agreement
      3. Please sign and return these forms along with a copy of your E&O declarations and a W-9 to signup@specialtyis.com.
      4. One of our underwriters will reach out to help you get started.
We are currently only signing up agents that are licensed to write business in Florida.
Agent SignUp

Agency Information

Agency Primary Location

Mailing Address

Additional info

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List Owners/Officers

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List Licensed Personnel (Primary Agent First)

Primary Carriers

Wholesale Brokers

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(904) 743-4314(844) 665-0300 |  hello@specialtyis.com | P.O. Box 5517 Jacksonville, FL 32247