Release Request Form

Release Request Form

This form is required and must be completed in full to begin the release process with Trusted Senior Specialists.
Name of Agent Requesting the Release? *

First Name Last Name
What Carrier(s) are Being Requested? *
Name of the New FMO You are Moving to? *
City and State Where the New FMO is Located? *
Name of the Principal Agent at the New FMO? *
Reason You are Requesting a Release? *
Release Policy: To be eligible for release the following requirements must be met: 1)Agent must have a $0 debit balance for all carriers being released. 2)Must have approval from any middle tier agent/agency if not direct to TSS. 3)Releases for past employees are considered on a case-by-case basis. Other factors may be considered and are subject to approval by a Principal of TSS. Please check "Yes, I understand" below to acknowledge your understanding and agreement with this process, then sign in the box below to begin the release process. *

Yes, I understand.
Agency Partners: If you are completing the release request form on behalf of a downline agent/agency, please select which type of release you wish to provide.
Please note that if you do not make a selection above, a standard Letter of Release will be provided so long as the agent has a $0 debit balance with all carriers.
Please upload a copy of the Reciprocal Release Agreement (if applicable).

Cancel of
Signature *

Clear
Should be Empty: