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Agency Profile

Become a JM Wilson Agent

Please enter a valid EIN in the format 00-0000000.
Agency’s Primary Physical Address:
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Mailing Address:
States Licensed In:
Ownership

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Owner

Key Contacts:
Receive Policies and Endorsements
Receive Statements and Billing Communications
Main Contact for Questions/Updates
Additional Contacts:
Contact

Premium Volumes
Please list Wholesalers/MGAs you placed business with last year:
Wholesaler/MGA

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Errors and Omissions Insurance

The above information is true to the best of my knowledge. I authorize JM Wilson to make whatever inquiries they deem necessary to approve this application for appointment to do business with them. Investigation will include a credit report.

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