I hereby request that Teague Financial Insurance Services (NPN: 2746759) becomes my broker under the agent April Hammett (NPN: 7992737), effective immediately or on the 1st day of next
As proof of consent and current enrollment, find a copy of my insurance member ID card and signature. This letter also constitutes your authority to furnish my new representative with all information they may request as it pertains to our insurance contracts, rates, rating, schedules, services, reserves, retention and all other data as if they were my original agent of record.
This recognition as our broker entitles them to any and all compensation paid by your company in conjunction with the placement, installation, and servicing of our insurance.