White Eagle Affiliate Agency Application

Welcome to White Eagle Insurance Solutions Agent Application

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Our process is quick and streamlined. Complete our simple application, and our team of reviewers will send confirmation of approval or rejection within 24 hours of submission. Upon approval, a team leader will arrange a date and time for training and introduction to the host of White Eagle Insurance Solutions products and tools you’ll have at your fingertips. Note - If you get rejected, you’ll be provided instructions to appeal for further application review.

Questions:
- email agent@whiteeagleca.com
- phone (916) 545-7515
- jump on our calendar to chat: Chat with Us
Agent/Agency Information
Are you signing up as an:*

Independent Agent, to be appointed directly with White EagleAgency
Name of Agency
DBA
Primary Location
FEIN
Agency Website
Agency Email
Agency Contact
Contact Email
List all licenses for each state in which the agency wishes to write business with White Eagle, including resident and non-resident licenses:
Agent Information
For each Agent / Producer using the system, please provide the following information:*
Upload a copy of the Agency/Agent P&C licenses for each state

You can also send licenses via email to service@whiteeagleca.com.
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Upload a signed W-9 for the Agency and each Agent

You can also send your W-9 via email to service@whiteeagleca.com.
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Upload your Certificate of Insurance for the Agency's or Agent's Errors and Omissions coverage showing White Eagle as additional insured.

You can also send certificates via email to service@whiteeagleca.com.
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Upload a copy of license(s) for each Agent / Producer:

You can also send license(s) to service@whiteeagleca.com
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Notes / Comments
Please verify that you are human*
Print Name*
Send confirmation email to:
Please enter an email address.
Signature*

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White Eagle Insurance Solutions, LLC

(800) 657-5202
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Welcome to White Eagle Insurance Solutions Agent Application

Agent/Agency Information

Agent Information