2022-2023 Agency Membership Application

MEMBERSHIP INFORMATION

Eligibility: Any individual, firm or corporation who is licensed as a Maryland insurance producer, as defined in Article 1-101 (q) of the Annotated Code of Maryland, and operating on a commission and/or fee basis on his/her own account.

Dues Schedule: Big I Maryland membership dues are based on an agency's property/casualty premium volume written in Maryland. Volume must include all owned (greater than 50%) subsidiaries and branches. Membership with Big I Maryland automatically includes membership in the Independent Insurance Agents and Brokers of America (Big I) and Trusted Choice.

Please see the dues chart below - The membership dues cycle runs from 9/1-8/31.

Level	Premium Volume	Dues
Level 1	$0 - $500,000	$450
Level 2	$500,001 - $1,000,000	$550
Level 3	$1,000,001 - $2,000,000	$750
Level 4	$2,000,001 - $3,000,000	$950
Level 5	$3,000,001 - $5,000,000	$1,200
Level 6	$5,000,001 - $7,000,000	$1,400
Level 7	$7,000,001 - $9,000,000	$1,600
Level 8	$9,000,001 - $12,000,000	$1,800
Level 9	$12,000,001 - $15,000,000	$2,000
Level 10	$15,000,001 & Above	$2,200

AGENCY INFORMATION
Date of Establishment: (MMYY) *
Business Entity:
Agency Name: *
Physical Address: *
City: *
Zip Code: *
County: *
Mailing address (if different from above):
Phone Number: *

Area Code Phone Number
Fax Number:

Area Code Phone Number
Website: *
How many office locations do you have? *
Please list addresses below:

Agency Contact Information
Principal/Owner *
Email: *
example@example.com
Main Contact:
If different from principal/owner
Title:
Main Contact Email:
example@example.com
Additional Agency Personnel
Additional Agency Personnel: It is important to list all agency personnel in order to ensure they have full access to and login information for www.BigIMD.com and www.independentagent.com.

You may also list all employees on an excel spreadsheet an email to membership@bigimd.com.
Name

First Name Last Name
Email
example@example.com
Name

First Name Last Name
Email
example@example.com
Name

First Name Last Name
Email
example@example.com
Name

First Name Last Name
Email
example@example.com
Name

First Name Last Name
Email
example@example.com

ADDITIONAL INFORMATION
This agency is contractually free to represent multiple (check all that apply): *

P/C Companies L/H Companies
Main carriers currently appointed with: *
Total Number of Employees: (including yourself) *
E&O Carrier: *
Expiration Date (MMYY): *
Information Request
Please send me the following:

E&O Application Cyber Application RLI (PUP/IHB) Agreements

Information Request