AGENCY INFO REPORT - Burns & Wilcox 2025

1. Click ‘Get Form’ to open the AGENCY INFO REPORT in the editor.
2. Begin by filling out the 'Select an Office' section, ensuring you choose the correct office from the dropdown menu.
3. In the 'Contact at Burns & Wilcox' field, enter your primary contact person's name and details.
4. Complete the 'Agency (Tax Filing Name for 1099)' and 'DBA' sections with your agency's official names.
5. Fill in your agency's address, including City, State, and ZIP Code, followed by your phone number and fax number.
6. Provide your agency's year established and email address. Don't forget to include your website URL if applicable.
7. Indicate whether your agency belongs to any affiliate or parent company by selecting 'Yes' or 'No' and providing details if necessary.
8. For financial information, input total agency volume and E&S figures in their respective fields.
9. List admitted carriers represented by your office along with their premium volumes in the designated sections.
10. Finally, attach all required documents such as Producer Agreement and W-9 by uploading them at the end of the form before submission.

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