Insurance Broker Preferences
For Operations Use (Broker may update from time to time) All questions are optional.
Brokerage Name
full legal name
Merit Broker Code
Email of Sender
example@example.com
Category Preferences (check as many as required)
Info about Brokerage
Funding Information
Communication
Inception Payments
Support
Information about brokerage
Main Telephone Number
-
Area Code
Phone Number
Head Office Address
Street Address
Street Address Line 2
City
Province
Postal
Broker Principals
Key Contact Email
example@example.com
Key Contact Direct Telephone Number
-
Area Code
Phone Number
Accounting Primary Contact
First Name
Last Name
Accounting Email
example@example.com
Cancellations Primary Contact
First Name
Last Name
Cancellations Primary Email Contact
example@example.com
Broker Management System Used, if any
Broker License Number(s) with applicable Province
Number of Offices
Fax Number
-
Area Code
Phone Number
Broker Website Address
e.g., www.meritfinance.net
MeritMaster Portal Users by email acct
Insurance Companies and MGAs used
Merit to withdraw all Inception Payments
Send Correspondence by:
Please Select
Email
Fax
Mail
If any special requests, please add details
Preference for Sending Payable
Mail
ICS
EFT
Secure Upload Copy of Void Brokerage Cheque for Payment of Insurance Funding
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of
Name of Bank or Financial Institution
Initials and Bank Identifier (e.g. RBC 003)
Routing Number
Bank Account Number
Specific Details, Compliments, Complaints, Requests or Information
Other Optional Documentation for Upload to Merit
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of
Signature Authorization
Register for The Merit Times (with operational information)
If desired, Relationship Support (training or tuning or like to chat)
Email Validator
*
Happy to Refer Merit to Colleagues
1
2
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Like you, we grow by referrals and appreciate your support
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