NSD REMITTANCE REPORT - Conley Insurance Group: Fill out & sign online

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Click ‘Get Form’ to open the NSD REMITTANCE REPORT in the editor.
Begin by entering the Dealer Name and Dealer/Producer Code # in the designated fields at the top of the form.
Fill in the Physical Address, City, State, and Zip code to ensure accurate contact information.
Input the Date, Telephone #, Fax #, and Contact Person's details along with their Tel # and Ext for easy communication.
Complete sections for Effective Date, Customer Name, Product, Term Length, and Cost as applicable to your transaction.
Make sure to indicate where checks should be payable by filling in 'MAKE CHECKS PAYABLE TO' with Conley Insurance Group, Inc.
In the internal use section, enter TOTAL APP’S SUBMITTED and TOTAL DUE TO NSD accurately.
Finally, document any overpayment or shortage details before saving or submitting your completed report.

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