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Progressive Carrier ProfileType of Billing: Direct BillHow to Quote: Carrier Website, EZ LynxDownload to Instar: YesEZ Lynx Integration: YesGeographic Restrictions: NoneMarket Lines of Business and Gross Commissions: Personal AutoCommercial AutoWatercraftMotorcycleTravel Trailer10.0% New / 10.0% Renewal10.0% New / 10.0% Renewal10.0% New / 10.0% Renewal15.0% New / 10.0% Renewal10.0% New / 10.0% RenewalType of Appointment: Integra Sub Agent CodeCommission 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 FormPremium Sweep AuthorizationProgressive Felony FormProgressive FCRA FormW9 (Integra Signed – include with your other forms)Appointment Process/Instructions:1. Complete all forms.2. Email completed forms to progressiveappoint@integrainsuranceservices.com3. Please list the subject line of your email “New Integra Appointment Request - (Name ofProducer)”.Most Progressive appointments take 3 weeks to process from the time that you submit your emailassuming all forms are complete.
EXPRESS TRANSFER AUTOMATED CLEARING HOUSE AUTHORIZATIONThe Progressive Group of Insurance Companies (Progressive) is hereby authorized to presentExpress transfer items (posting credit and debit entries) with the agency’s bank account indicatedbelow and the depository named below for payment of settlements due to Progressive by theagency 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. Thisauthorization 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 NumberBank Address (street, city, state, zip)3.Name/Title on Bank Account4.5.Checking Account Number (from check)Bank Routing Number (from check)6.Agency Name7.Agency Code8.Agency Contact Person and Telephone Number9. 10.Authorized Signature on the AccountDate11. 12.Agency Audit Contact PersonBank Fee for returned deposit item13. 14.Name of Progressive Territory Sales ManagerEffective date for account changesIf 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 transfervia the Automated Clearing House (ACH) network.
EXPRESS TRANSFER AUTOMATED CLEARING HOUSE AUTHORIZATIONBefore using EXPRESS, you must complete an authorization form. This form authorizesthe electronic transfer of funds for payment or credit on your bank account.The authorization form also provides Progressive with the necessary details to processEXPRESS transactions.Please attach a voided or cancelled bank check to this form so that Progressive can retainthe bank account and routing information.Fax the authorization form, along with the voided or cancelled check, to a Progressive AgencyLicensing Coordinator at 1-888-316-0107.INSTRUCTIONS FOR COMPLETING THE AUTHORIZATION FORM1. 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 isalso 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 ofnumbers on the bottom of your check.5. Routing number: if you attached a bank deposit slip, please verify that the routing number isthe 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 ofsomeone in your agency who is familiar with Express transactions, in the event we need tocontact 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 auditsbetween Drive Insurance and the agency.12. Bank fee for returned deposit item: The amount your bank charges when an item is returned forspecial handling. (Amount is typically between 10 or less, and is not related to an NSF overdraftcharge.)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 tThe federal Violent Crime Control and Law Enforcement Act of 1994 requires that no person who hasbeen convicted of a felony involving “dishonesty” or “a breach of trust” participate in the “businessof insurance”. Criminal penalties for violation of the Act apply to Progressive and to you, andtherefore, as a condition of your producer relationship with Progressive, you are required to answerthe 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 knownSocial Security #:Date of Birth:Agent Code:Agency Name:Signature:PrintReset090901 FelonyAffidavit-03 kab
FAIR CREDIT REPORTING ACT DISCLOSURE & AUTHORIZATIONPlease print, sign and fax to Progressive’s Secured Fax Number 1-888-316-0107Please read the following and indicate your agreement by signing below.Please Print Name:Progressive Casualty Insurance Company or its affiliates (“Progressive”), in considering youreligibility to act as an independent agent on behalf of Progressive, will attempt to obtainand use information about you from “consumer reports.”A “consumer report” is any written, oral or other communication of any information by aconsumer 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 theconsumer’s eligibility for employment purposes. It includes an “investigative consumerreport,” which contains information concerning a consumer’s character, general reputation,or personal characteristics obtained through personal interviews with persons who may haveknowledge 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 reportingagency that furnished the report. For 60 days following receipt of the notice, you will have aright to obtain a free copy of the consumer report and dispute with the consumer reportingagency the accuracy or completeness of any information in it.You are also free to contact the Federal Trade Commission about your rights under the FairCredit Reporting Act (“FCRA”). You may request in writing that Progressive disclose thenature and scope of any investigative consumer report and provide a written summary ofyour rights under the FCRA.AUTHORIZATIONBy signing below, you authorize Progressive to obtain “consumer reports” about you forpurposes of determining your eligibility to act as an independent agent on behalf ofProgressive. This authorization includes the release to Progressive of your residence addressand other information in any state Department of Motor Vehicle’s records, and you herebywaive the application requirements of Section 1808.21 of the California Vehicle Code to theextent it would prohibit the release of such information. This authorization shall remain on fileand serve as an ongoing authorization for Progressive to procure consumer reports aboutyou 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 investigativeconsumer report requested by Progressive by contacting EmployeescreenIQ (or such otherconsumer reporting agency as may be identified by Progressive) directly. Check this box if you wish to be informed whether a consumer report was requestedand the name and address of the consumer reporting agency. Even if you do not check thisbox, you may request this information at any time by contacting Progressive at: AttentionBIU; 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 Progressivemay 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 (asthat 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 provideyou with a complete and accurate disclosure of the nature and scope of any consumerreport about you obtained by Progressive. Check this box if you wish the consumer reportingagency 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 byProgressive 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 todirectly 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 duringyour adult lifetime (city & state only)All the locations you have worked duringyour adult lifetime (city & state only)Locations of any high schools, colleges orgraduate schools you may have attended(city & state only)122909 FairCreditAct
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
