Complete the following form to register for a Schinnerer Flood portal account. You will receive an email within 24 hours containing your username and password.
  

Agency name     Agency principal  
DBA        
       
Mailing address     City
State     Zip code
       
Physical address     City
State   Zip code
       
Agency FEIN/TaxID      
Phone number      
Fax number      
Agent email address      
Commission/accounting email address    
       
E&O carrier       Policy #
Effective Date    [None] Select a Date Delete the Date Policy limits
       
ACH Deposit of commissions 
 
               
   
Bank name      
ABA or Routing #   

Account #      
       
ACH sweep for insurance premium  
               

 
Bank name    
Routing#  
Account #    
       
       
To register additional agents at your firm, fill out the information below: 
 
Agent Name(s):
License #:
CSR(s) within agency
 
 

 
 
       
       
  I am certified to sell flood insurance.
   

Your office will receive 20% new and renewal commission.
   

 

  

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