Become a Broker

As a Black, Gould & Associates partner, you get the best of both worlds: the personalized support of your local general agency backed by the national footprint and resources of Warner Pacific.

  • Access a broad national carrier network while keeping your same local BGA relationships.
  • Leverage Warner Pacific tools, technology, and expertise to grow your book of business.
  • Rely on responsive, relationship-driven service from people who know your market.
Happy business professionals walking and smiling.

How to get started

Please submit the following paperwork to marketing@blackgould.com so that we may enter your information into our systems.

  1. A completed broker licensing questionnaire

  2. A completed IRS W-9 form

  3. A signed HIPAA privacy statement

  4. A completed direct deposit authorization form (along with a copy of a voided check)

  5. A copy of your insurance license

  6. A copy of your E&O Insurance Certificate

Forms

Broker Licensing Packet

Download
Forms

Bussiness Associate Agreement | Agent/Agency and General Agent

Download
Forms

Direct Deposit Authorization Form

Download
Forms

HIPAA Business Associate Agreement

Download
Forms

IRS W-9 Request for Taxpayer ID Number

Download
Forms

Licensing Information Questionnaire

Download
Forms

Update Broker Information Form

Download

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