EAGLE STATEWIDE • AGENT NETWORK

Independent Agent Agreement

Review and complete your Independent Agent Agreement to continue
the Eagle Statewide onboarding process.


01

Review


02

Complete & Sign


03

Submit


Before You Continue

Please review the agreement carefully and make sure all information
you provide is complete and accurate before electronically signing
and submitting the form.


AGENT AGREEMENT FORM

Complete & Sign Your Agreement

Enter the requested information below, review the agreement
carefully and complete your electronic signature.

CONTRACT FOR INDEPENDENT INSURANCE AGENT – Step 1 of 4

Introduction to Independent Agent Agreement

Dear Agent:

Thank you for your interest in joining Eagle Statewide as an independent insurance agent. This Independent Agent Agreement outlines the terms and conditions that govern your professional relationship with our company.

As an independent contractor, you will have the opportunity to represent and sell a variety of insurance products while maintaining the flexibility to manage your business independently. This agreement sets forth the expectations, responsibilities, and compensation structure to ensure a mutually beneficial partnership.

Please read the terms of this agreement carefully before signing. By signing, you acknowledge that you understand and agree to the terms outlined, including but not limited to:
✔️ Your role and responsibilities as an independent agent
✔️ Commission structure and payment terms
✔️ Compliance with all legal and regulatory requirements
✔️ Confidentiality and data protection policies
✔️ Contract termination and renewal provisions

If you have any questions or require clarification regarding any section of this agreement, please contact us before signing.

We look forward to a successful and productive collaboration!

Eagle State Team


ELECTRONIC SIGNATURE

Please Review Before Submitting

By electronically signing and submitting the agreement,
you acknowledge that you have had an opportunity to review
the terms presented and that the information you provide
is accurate to the best of your knowledge.


Important

Submitting or electronically signing this agreement does not
automatically guarantee appointment, carrier access, producer
authorization, compensation level or acceptance into any
Eagle Statewide program. Eligibility remains subject to licensing,
agency review, applicable agreements and carrier requirements.


AGENT SUPPORT

Need Help With Your Agreement?

Contact Eagle Statewide if you have questions before completing
or signing your agreement.