Become an Agent with Unique Insurance Managers Unique Insurance Managers understands just how critical our independent agents are to our everyday success. If you would like to be considered for an appointment with us, please complete the form below. Step 1 of 3 33% Agency InformationAgency NameAddress Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Agency TelephoneDate Agency Established MM slash DD slash YYYY Email Contact PersonName First Last TitleMr.Mrs.MissMs.Dr.Phone NumberDoes this agency have additional locations? Yes No Please list all additional locationsAgency SizeTotal Agency Premium VolumePersonal Lines VolumeAny E & O Claims for the agency or current agency personnel? Yes No Please provide an explanation LegalHas any owner, officer, director, partner, producer or employee of the firm been the subject of an investigation and/or disciplinary action by any insurance authority? Yes No Please provide a full explanationAre you a member of any professional insurance associations or societies? Yes No Please list their names:In the last 3 years has the agency been terminated by any homeowners carriers? Yes No Please provide reason:Are you a member of any professional insurance associations or societies? Yes No Please list their names:Please list any additional information:CAPTCHA
