Broker Appointments

Please fill out the below form if you're interested in joining our network of brokers.

Broker Information

Full Name

Position

Email

Phone

Company name

Corporate Address

Primary homestate of business:

Other states operating in:

Total Agency Volume (Premium)

Total Commercial Real Estate Volume (Premium):

Total E&S Commercial Real Estate Premium (est.):

Of that, what % is Commercial

Of that, what % is Residential

Monthly # of E&S Commercial Real Estate Binds (avg):

Current E&S Markets

Please share the value you see in an appointment with CIBA

If applicable, estimated premium from existing portfolio roll:

Anticipated # of submissions sent to CIBA monthly:

Anticipated # of Binds with CIBA Quarterly:

Anticipated 1st year premium

Please note: BORs not accepted during first 12 months of appointment