Appointment Forms

If you wish to receive commission from Progressive's bank program, you must complete the following forms.

PLEASE NOTE: These forms are specific to financial institution coverages only (Directors & Officers Liability, Employment Practices Liability Financial Institution Bond, STAMP, etc.) and cannot be used to appoint you for other coverages sold by Progressive, such as personal or commercial auto. Similarly, a personal or commercial auto appointment does not appoint you for the financial institution coverages.

Agents with Current Progressive Auto Appointments

• The Producer's Agreement
  

One per agency. It must be signed by an officer of the agency with an original signature. We cannot accept the signature of anyone other than an officer of the agency.

• Felony Affidavit
  

If the affidavit on file was executed more than two years prior to current date.

Agents Not Yet Appointed by Progressive

• The Producer's Agreement (as described above)
  

• The Agent/Agency Appointment Information Forms
  

These forms will provide us with the information needed to appoint your agency and desired agents. We cannot appoint without them. These include:

- Felony Affidavit
- Background Check Authorization Form. Required by law.

NOTE: Only a criminal background check will be conducted.

- Agency Information Form
- Proof of Errors & Omissions Coverage

Licenses
Please provide a copy of your agency’s residential license, as well as a copy of the residential license for each agent completing the Agent Appointment Information Form. If you would like to be appointed in additional states, please include a copy of the non-resident license for the agency and each agent to be appointed in that particular state. (Non-resident Agency licenses are not required for IA, RI, TN, VT and WI).

Broker licenses cannot be accepted with the exception of California and New York.

Our licensing department will submit your appointment(s) for each state as requested.

State Specifics and Exceptions

• Brokers (CA and NY)
  

Appointment set ups are now required for all California and New York brokers. All of the steps related to an agent appointment apply; however, a broker license is supplied in place of an agent license.

• Massachusetts Specifics
  

Each officer of the agency must complete an Agent Appointment Information Form and submit an individual license. Any agent not listed as an officer and desiring an appointment must also complete an Agent Appointment Information Form and submit their individual producer license.

• Washington Specifics
  

Please include an Affiliation Certificate along with agent license.

• DBA License Requirements
  

If a DBA is used, valid DBA paperwork needs to be included.

Please return all forms to:

Progressive
PLG-OHL21
5920 Landerbrook Drive
Mayfield Heights, OH 44124
Phone: (800) 274-5222