Appointment Request

Amwins is a specialty insurance broker that works with retail agents, brokers and consultants to place coverage for insureds.

If you are a retail agent or broker that would like to transact business with Amwins, you will need to become appointed with us. In order for us to provide you with the necessary paperwork, we ask that you please complete the following form.

Agency Name *

Contact Name for Appointment Request *

Contact Phone Number *

Contact Email Address *

Agency Address

Street Address

City *

State *

Zip *

Types of Business

Please enter the types of business you’re looking to market through Amwins. Please include information such as coverages, classes, and size of account(s). This will allow us to best align you with the resources who can help.