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. (NO RELEASES GRANTED BETWEEN 8/1 AND 12/31)
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 or Carrier Specific Release/Transfer Form (as applicable).

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