🌿 Lilypad Insurance — Agency Onboarding
Agency Information
Agency Name
DBA (if applicable)
FEIN / Tax ID
Year Established
Website
Main Contact Name
Phone
Contact Email
Mailing Address
Street Address
City
State
Select...
Alabama
Florida
Louisiana
Mississippi
North Carolina
South Carolina
Texas
ZIP Code
Physical address is different from mailing address
Physical Street Address
City
State
Select...
Alabama
Florida
Louisiana
Mississippi
North Carolina
South Carolina
Texas
ZIP
Business Details
States you intend to write business in
Alabama
Florida
Louisiana
Mississippi
North Carolina
South Carolina
Texas
Products you intend to write
Personal Lines (HO3, HO6, DP3, HO4)
Commercial Residential (CRP)
Business Owners Policy (BOP)
Flood
Agency Management Platform
Do you use IVANS Download?
Select...
Yes
No
Not Sure
IVANS Y-Account Number (if applicable)
Will you be writing commercial business?
Select...
Yes
No
Commission & Banking
Preferred Payment Method
Select...
ACH
Check
Commission Contact Name
Commission Email
Bank Name
Routing Number
Account Number
Account Type
Select...
Checking
Savings
Producers / Agents
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