Contact Colonial Lloyds

Colonial Lloyds welcomes new agents in Texas. Please complete this brief form and click submit below for a prompt reply.

New Agent Information Form
* Required Fields

^*Agency Name:
DBA (if different than above):
Mailing Address
^*Address:
^*City:
^*State/Zip:	-
Physical Address (if different than above)
Address:
City:
State/Zip:	-
^*Business Phone:	- -
Fax Phone:	- -
^*Email:
Website:
Agency Principal(s):
Appointed Agent:
^*License #:		License Exp Date:
Contact Person:
Name of E & O Company:		Effective Date:
^*Years in Business:		Years in Present Location:
Personal Lines Volume:
Current Personal Lines Companies:
Top 5
Are you currently or have you previously been appointed to write coverage with Colonial Lloyds.
	Yes No
	If yes, please list the name of the Managing General Agents
Additional Notes: