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COVER AGENCY, Ltd

Broker Registration Form



Cover Agency, Ltd
Licensed Insurance Broker Registration Request Form

Contact Information: Priscilla Li, Vice President
Direct: (347) 886-9778   Office: (718) 591-2400   Email: priscillali@coveragency.biz


A Broker  Registration Request may be submitted either before, or simultaneously with, submitting a Fast Quote Application or other insurance application.

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Broker First Name:
Broker Last Name:
Company Name:
Street:Address
City:
Zip Code: (5 digits)
State:
Office Phone
Cell Phone:
 Email:

License Number:
License State:
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COVER AGENCY, Ltd

Wholesale Insurance

Index

BROKER REGISTRATION

TOP Commissions

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Artisan Liability

Auto Dealers-Call 718-591-2400

Auto Repair Shops

Automated Crime Fidelity Insure

Automated Director Officers Liab

Automated Employ Pract Liab

Automated Fiduciary Liab

Automated Int'l Travel

Automated Managment Liab

Automated Motor Truck Cargo

Automated Prof'l Liab

Automated Quotes

Automated Umbrella Liab

Bonds - Call 718-591-2400

BOP- Business or Real Estate

Construction Insurance

Contamination insurance

Contractor G Liability NY

Contractor Liab IL IN OH CT

covermultistate.com

Creditinsurance.biz

Critical Illness Insurance

Data Breach Ins - Low Cost

Disability Income-Sickness To 70

718-591-2400

Disability Income Bus's Buyout

Disability Inc- Lump Sum Paid

Disability Inc- $50,000,000 Maximum

Disability Income - London

Educators Liability Insurance

Employment Practices Liability

Environment Company Pollute

Environment Contractor Pollute

Environment Healthcare Site Liab

Environment Prof Liability Svces

Environmental Insurance

Environmental Site Pollution

Excess Disability Income-BIG

Fiduciary Insurance Pkg

Food Industry Call 718-591-2400

Garage Liability - Keepers

Health Hipaa Info Data Liab

Homeowner 12 Payments NY

Inland Marine Insurance

insurancefor.ws

internationalinsurance.us

Int'l Comprehensive Bus's

Int'l Health Ins: 718-591-2400

Int'l Travel & Business

itsecurity.cc

Kidnap, Ransom, Extortion Ins

Lawyer Malpractice

Lessor Ins Call 718-591-2400

Life  Sciences Industry Pkg

Long Term Care Insurance

Lumber Products Pkg-Call 718-591-2400

Malpractice Non-Standard Lawyer

Malpractice Attorney's LowCost

Medical Data HIPAA Liability

Medical Facility Liability Pkg

Medical Facility Umbrella Liab

Medical Facility Pollution Liab

Medical Facility EPLI, D&O, Fidelity

Merger and Acquisition Ins

Motor Truck Cargo Ins

NY ACTION OVER COVERAGE - Call Yes

NY Action Over Coverage-Yes

Ocean Marine Insurance

policiespackaged.com

Product Recall Ins

Professional Liability 900 Classes

Prof Liability- Architect, Engineer

Professional Liability- Contractor

Public Entity Town Utility Liab

Real Estate - Superior Programs

Real Estate-Big Capacity 7185912400

Recreation, Sports Pkg- Call 718-591-2400

Restaurant Contamination Insure

Restaurants - Call 718-591-2400

Restaurants, TakeOut 718-591-2400

Retail, Wholesale, Mfger

Structured Credit Ins 718-591-2400

Sub-Contractor Liability NY CT IL IN OH

Superior BOP

Surety Bond - Call 718-591-2400

Technology Company Pkg

transactioninsurance.net

Truck Insurance NY CT

Umbrella Liability Classes

Vacant Realty-Call 718-591-2400

Web Company Pkg

wholesaleinsurance.us

Wood Products Pkg 718-591-2400

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