Progressive Carrier Profile

Progressive Carrier Profile
Type of Billing: Direct Bill
How to Quote: Carrier Website, EZ Lynx
Download to Instar: Yes
EZ Lynx Integration: Yes
Geographic Restrictions: None
Market Lines of Business and Gross Commissions:
•
•
•
•
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Personal Auto
Commercial Auto
Watercraft
Motorcycle
Travel Trailer
10.0% New / 10.0% Renewal
10.0% New / 10.0% Renewal
10.0% New / 10.0% Renewal
15.0% New / 10.0% Renewal
10.0% New / 10.0% Renewal
Type of Appointment: Integra Sub Agent Code
Commission Paid As – Sub Location Code
(Please refer to your commission exhibit for a detailed definition)
Progressive offers sub appointments to Integra Partner Agents immediately with no required PIF count.
Appointment Documents Required:
1.
2.
3.
4.
5.
Additional Location Form
Premium Sweep Authorization
Progressive Felony Form
Progressive FCRA Form
W9 (Integra Signed – include with your other forms)
Appointment Process/Instructions:
1. Complete all forms.
2. Email completed forms to [email protected]
3. Please list the subject line of your email “New Integra Appointment Request - (Name of
Producer)”.
Most Progressive appointments take 3 weeks to process from the time that you submit your email
assuming all forms are complete.
EXPRESS TRANSFER AUTOMATED CLEARING HOUSE AUTHORIZATION
The Progressive Group of Insurance Companies (Progressive) is hereby authorized to present
Express transfer items (posting credit and debit entries) with the agency’s bank account indicated
below and the depository named below for payment of settlements due to Progressive by the
agency or for payment of settlements due to the agency by our company.
The undersigned represents that s/he is an authorized signer on this account.
This arrangement does not affect the agency’s primary obligation for payment. This
authorization is to remain in effect until we are notified in writing to the contrary.
1.
______________________________________________________________________________________
Bank Name and Branch (or Main Office)
2.
Bank Phone Number
______________________________________________________________________________________
Bank Address (street, city, state, zip)
3.
______________________________________________________________________________________
Name/Title on Bank Account
4.
______________________________________________ 5.______________________________________________
Checking Account Number (from check)
Bank Routing Number (from check)
6.
_____________________________________________
Agency Name
7._____________________________________________
Agency Code
8. _______________________________________________________________________________________________
Agency Contact Person and Telephone Number
9. ___________________________________________________ 10._______________________________________
Authorized Signature on the Account
Date
11. __________________________________________ 12. _______________________________________________
Agency Audit Contact Person
Bank Fee for returned deposit item
13. __________________________________________ 14. _______________________________________________
Name of Progressive Territory Sales Manager
Effective date for account changes
If this is a change from an existing account, please indicate effective date of change.
Express Money transfer is a Progressive product to transact electronic funds transfer
via the Automated Clearing House (ACH) network.
EXPRESS TRANSFER AUTOMATED CLEARING HOUSE AUTHORIZATION
Before using EXPRESS, you must complete an authorization form. This form authorizes
the electronic transfer of funds for payment or credit on your bank account.
The authorization form also provides Progressive with the necessary details to process
EXPRESS transactions.
Please attach a voided or cancelled bank check to this form so that Progressive can retain
the bank account and routing information.
Fax the authorization form, along with the voided or cancelled check, to a Progressive Agency
Licensing Coordinator at 1-888-316-0107.
INSTRUCTIONS FOR COMPLETING THE AUTHORIZATION FORM
1. Bank name and branch: provide the name of the bank where your account is located. Also,
indicate whether your bank is a branch office or the main office. The bank phone number is
also needed.
2. Bank address: indicate the street, city, state, and ZIP code of your bank.
3. Name/title on bank account: provide the legal name on the account, i.e., The ABC Agency.
4. Checking account number: indicate your bank account number. This is usually the last set of
numbers on the bottom of your check.
5. Routing number: if you attached a bank deposit slip, please verify that the routing number is
the same as the one on your checks.
6. Agency name: provide your agency’s full legal name.
7. Agency code: provide the agency code for which Express transactions are authorized. (Note:
If there are multiple agency codes for this particular bank account, please list them all.)
8. Agency contact person and telephone number: provide the name and telephone number of
someone in your agency who is familiar with Express transactions, in the event we need to
contact you.
9. Authorized signature on the account.
10. Date: Please list the date that you sign the document.
11. Agency audit contact person: name of the agency contact person who will handle file audits
between Drive Insurance and the agency.
12. Bank fee for returned deposit item: The amount your bank charges when an item is returned for
special handling. (Amount is typically between $10 or less, and is not related to an NSF overdraft
charge.)
13. Name of Progressive’s territory sales manager.
14. Effective date for account changes.
F e l o n y A ff i d a v i t A c k n o w l e d g e m e n t
The federal Violent Crime Control and Law Enforcement Act of 1994 requires that no person who has
been convicted of a felony involving “dishonesty” or “a breach of trust” participate in the “business
of insurance”. Criminal penalties for violation of the Act apply to Progressive and to you, and
therefore, as a condition of your producer relationship with Progressive, you are required to answer
the following question:
Have you ever been convicted of a felony involving “dishonesty or “a breach of trust”?
 YES, I have been convicted of a felony involving “dishonesty or “a breach of trust”
 NO, I have not been convicted of a felony involving “dishonesty or “a breach of trust”
Date:
Name:
(As shown on your resident license)
Other Names:
(including maiden name), if any, by which you have been known
Social Security #:
Date of Birth:
Agent Code:
Agency Name:
Signature:
Print
Reset
090901 FelonyAffidavit-03 kab
FAIR CREDIT REPORTING ACT DISCLOSURE & AUTHORIZATION
Please print, sign and fax to Progressive’s Secured Fax Number 1-888-316-0107
Please read the following and indicate your agreement by signing below.
Please Print Name: ______________________________________________________________________
Progressive Casualty Insurance Company or its affiliates (“Progressive”), in considering your
eligibility to act as an independent agent on behalf of Progressive, will attempt to obtain
and use information about you from “consumer reports.”
A “consumer report” is any written, oral or other communication of any information by a
consumer reporting agency bearing on a consumer’s credit worthiness, credit standing,
credit capacity, character, general reputation, personal characteristics, or mode of living,
which is used or collected for the purpose of serving as a factor in establishing the
consumer’s eligibility for employment purposes. It includes an “investigative consumer
report,” which contains information concerning a consumer’s character, general reputation,
or personal characteristics obtained through personal interviews with persons who may have
knowledge concerning such items of information.
If Progressive takes an adverse action based on information in a consumer report about you,
then Progressive will notify you of the adverse action and identify the consumer reporting
agency that furnished the report. For 60 days following receipt of the notice, you will have a
right to obtain a free copy of the consumer report and dispute with the consumer reporting
agency the accuracy or completeness of any information in it.
You are also free to contact the Federal Trade Commission about your rights under the Fair
Credit Reporting Act (“FCRA”). You may request in writing that Progressive disclose the
nature and scope of any investigative consumer report and provide a written summary of
your rights under the FCRA.
AUTHORIZATION
By signing below, you authorize Progressive to obtain “consumer reports” about you for
purposes of determining your eligibility to act as an independent agent on behalf of
Progressive. This authorization includes the release to Progressive of your residence address
and other information in any state Department of Motor Vehicle’s records, and you hereby
waive the application requirements of Section 1808.21 of the California Vehicle Code to the
extent it would prohibit the release of such information. This authorization shall remain on file
and serve as an ongoing authorization for Progressive to procure consumer reports about
you at any time while you are acting as an independent agent on behalf of Progressive.
If you live in New York: You have the right to inspect and receive a copy of any investigative
consumer report requested by Progressive by contacting EmployeescreenIQ (or such other
consumer reporting agency as may be identified by Progressive) directly.

Check this box if you wish to be informed whether a consumer report was requested
and the name and address of the consumer reporting agency. Even if you do not check this
box, you may request this information at any time by contacting Progressive at: Attention
BIU; 6300 Wilson Mills Road, Box N71A, Mayfield Village, OH 44143.
122909 FairCreditAct
If you live in California:
 Unless you check this box, we will provide to you a copy of public records that Progressive
may obtain about you. Check this box if you do not wish to receive a copy of these records.
Unless otherwise notified by Progressive, the source of any investigative consumer report (as
that term is defined under California law) will be EmployeescreenIQ, P.O. Box 22627,
Cleveland, OH 44122-0627, 1-800-235-3954.
If you live in Minnesota:
 You have the right to make a written request to the consumer reporting agency to provide
you with a complete and accurate disclosure of the nature and scope of any consumer
report about you obtained by Progressive. Check this box if you wish the consumer reporting
agency to provide this disclosure.
If you live in California, Minnesota, or Oklahoma:
 You have the right to request at no charge, a copy of any consumer reports obtained by
Progressive about you. Check this box if you wish to receive a copy of the consumer reports.
Note: If you check this box, Progressive will request the consumer reporting agency to
directly mail to you a copy of any consumer reports.
Date: ______________________________
Name:
_________________________________________________________________________________________
Other Names:
_________________________________________________________________________________________
Social Security #:
_________________________________________________ Date of Birth: _________________________
Current Residence:
_________________________________________________________________________________________
City:
_________________________________________________ State: _________________ Zip: ___________
Phone:
Signature:
(As shown on your resident license)
(including maiden name), if any, by which you have been known)
_________________________________________________
_________________________________________________________ Agency Code: ________________
All the locations you have lived during
your adult lifetime (city & state only)
All the locations you have worked during
your adult lifetime (city & state only)
Locations of any high schools, colleges or
graduate schools you may have attended
(city & state only)
122909 FairCreditAct