Patriot National Underwriters, Inc. | MGA/Surplus Lines Agency | Agent Application

New Agent Application

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Call for more information

800.291.6846

You may apply to be an Agent for Patriot National Underwriters, Inc. by completing and submitting an Agency Profile form, which we have provided for your convenience.

We have also provided a PNU contract for your use if you would like to complete the contract process prior to writing new business. This is not a requirement to submit business; if you prefer, the contract process can be completed after a policy is bound.

In addition to the signed contract, we require copies of the agency license(s), E&O certificate or declarations page, and a W-9 form, also provided below for your convenience.

Please fax the completed forms to 972.233.3487.

Thank you for your interest in Patriot National Underwriters, Inc.

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