Agent Appointment
BGA Licensing Information Form

License Information

Copy of License(s)

Commission Information

In order for commission to be paid the following EFT information must be completed. Commissions are deposited every Monday for balances over $5.
Commissions can only be paid to the entity that holds the license.
DO NOT submit a deposit slip

Carrier/Products Information

Note: we market additional carriers that do not require broker contracting.
Black, Gould & Associates, Inc. ("BGA") endeavors to maintain a culture of integrity and trust among our agent partners, employees, officers, and directors so as to reflect our values throughout our business actions. In order to provide our customers with a broad range of products and services as effectively and conveniently as possible, we use technology to manage and maintain customer information. The following policy serves as a standard for all BGA employees for collection, use, retention, and security of nonpublic personal information.
You will be contacted by BGA with a one-time, temporary password. You will be able to create your own password upon login.
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