Coastal Risk Underwriters is commited to the independent agent and broker distribution channel. We are currently interested in appointing agents and brokers as contract producers for CRU in specified geographical territories.
If you are interested in becoming appointed with CRU, please complete the online application below. A CRU representative will contact you within two business days of receipt.
Name of Applicant Producer:*
Address:*
City:*
State:* AL CT DE FL GA HI LA MA MD MS NC NJ NY PA RI SC TX VA
Zip:*
County:*
Contact Name:*
Email Address:*
Phone:*
Fax:
Year Agency Established:*
Year Current Owner Assumed Mgmt:*
Licensee Name:
Agent/Broker's License #:
Total P&C Gross Premium Written Annually (last 12 months):*
Total Surplus Lines Premium Written (last 12 months):*
Commercial Property - Multi-Peril:*
Homeowners Multi-Peril:*
Dwelling Fire:*
Carrier/Company % of Business # of Years Represented
*
* Required