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November 28, 2023
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9 Union St N, STE 400
Concord North Carolina 28025
704-773-9699
Client Support
Get a Quote Now
Coverages
Resources
CLIENT SERVICE
Get a Certificate
MVR Request
ADDITIONAL RESOURCES
YouTube Channel
Schedule a Call
Start Up Checklist
Owner Op Lease Agreement
Accident Release Form
Amazon Relay Intermodal and UIIA Loads
FAQs
TRUCKING LIBRARY
Recent
IRS VCSP – Voluntary Classification Settlement Program
March 13, 2024
How to Get Cheaper Truck Insurance Quotes
November 28, 2023
All Articles
Partners
Contact
About
Our Agency
About Us
Daniel Summers
YouTube Channel
Schedule a Call
Write a Google Review
Get in Touch
9 Union St N, STE 400
Concord North Carolina 28025
704-773-9699
Client Support
Get a Quote Now
Affiliate Partner Program
Affiliate Partner Program
Charles String
2024-08-07T20:51:50-04:00
Want to help your clients or audience find the best trucking insurance?
Join our affiliate program and start getting paid for every policy we bind with your referrals!
Step
1
of
5
20%
Are you applying as an individual or a business?
(Required)
Individual
Business
Should we pay you or your business for referrals?
Business Name
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Additional Contacts
Name
Phone
Email
Title/Role
Add
Remove
Please provide a brief summary of your business and where your referrals are coming from
Do you hold an active property and casualty insurance license?
(Required)
Yes
No
Agent NPN
(Required)
Agency NPN
(Required)
Upload Agent/Agency license(s)
(Required)
Drop files here or
Select files
Max. file size: 12 MB, Max. files: 2.
We only need your resident license(s).
Would you like us to create a custom landing page featuring you/your business on our website?
(Required)
Yes
No
We will include backlinks to your website and/or social media. (Helps people find you on Google)
Website
LinkedIn
Youtube
Instagram
Facebook
Tiktok
Upload any logos or graphics you would like us to use for the landing page.
Max. file size: 12 MB.
Have you been working with a specific agent?
(Required)
Yes
No
Agent
(Required)
Aaron Beeman
Austin Armstrong
Drew Moore
Emory Britt
Justin Barrow
Lily Sealy
Mike Davis
Nick Bullard
Sarah Moore
Other
Do you have a W-9 you can upload?
(Required)
Yes
No
Upload W-9
(Required)
Max. file size: 12 MB.
W-9
Tax Classification
(Required)
Sole Proprietor
C Corporation
S Corporation
LLC
Partnership
LLC Tax Sub-Classification
(Required)
C corporation
S corporation
Partnership
Social Security Number
(Required)
FEIN - Employer Identification Number
(Required)
Certification
(Required)
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Signature
Direct Deposit
Bank Name
Routing
Account
Upload Void Check (Optional)
Max. file size: 12 MB.
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