This form helps you and your team get paid faster. Once a policy has been issued and all delivery requirements are complete, please submit one form per application so commissions can be reviewed and processed as quickly as possible.
Important Notice: Your privacy is our priority. We do not share or sell your data, and it is only shared with insurers as needed. Submitting this application does not guarantee approval. No payments will be processed without your review and consent to your agent.
🔁 Follow-up on commission payment
🚫Commission Not received
📑 Commission Paid incorrectly
💵 Month-End Cutoff Push!
↩️ Chargeback
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Active E&O is required. Commissions may be held without it.
Yes
No
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Active Tevah account requiered to get paid
Yes
No
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