Enrollment Form

Enrollment Form

The information requested below is required for enrollment to sell flood insurance on behalf of your agency,
provided by the company you write with, in partnership with its approved vendor, National Flood Services (NFS).

1. Please complete all of the required fields in the form below.
2. Upload all of the required documentation, including a completed W-9.
3. Provide ALL producer’s names and P & C license numbers that will access the flood website (space provided below).
4. Links are provided for ACH and download enrollment (AL3) forms in the Upload Section.
5. A Welcome Packet will be emailed to your agency once the enrollment is reviewed and approved by NFS.

General Information

Company Name:

Agency Name:

Agency DBA:

Address:

Postal Code:

City:

State:

select

Check if mailing address is the same as the street address

Address:

Postal Code:

City:

State:

select

E-Mail Address:

Business Phone:

Business Fax:

Person to Contact for Policy Issuance Questions:

Agency NPN:

Numbers up to 10 digits

Producer Information

	First Name	Last Name	Email Address	P & C License # (Exactly as shown on license)	Agent NPN	Which states do you hold a non-resident license in?	Phone (If different than above)

Upload Documents

For faster processing, upload any of the forms listed below that you would normally fax or email.

Special Instructions

WYO Use Only

Enter any additional information we may need to complete the enrollment process in the space provided:
(i.e. Agency Code, Commission Exceptions, Marketing Rep Number, etc.)

Submitted By:

Please complete all of the mandatory fields.

Please enter your company’s PIN number:

Incorrect Pin Number

FEMA now requires that Agency National Producer Numbers (NPN) be on file. If you don’t have the Agency NPN, you can find it here

FEMA now requires that Agent National Producer Numbers (NPN) be on file. If you don’t have the Agent NPN, you can find it here