If you have any questions at all, give us a call at We look forward to working with you!

Transcription

1 Contracting with Neishloss & Fleming, Inc. is now easier than ever! Neishloss & Fleming, Inc. offers the services of SureLC for contracting with various Health, Life, and Senior carriers. With the exception of a few carriers, you will be able to contract for multiple carriers in about eight minutes or less with the click of a mouse. You can complete your agent profile and submit your complete contracting requests to Neishloss & Fleming, Inc. without having to fill out a single piece of paper! To begin contracting through SureLC, simply follow the link below to get started: Once the page loads, select New User? to register for SureLC (NOTE: If you have already registered for SureLC and you are adding a carrier to your profile, simply log in using the Login and Password that you previously created). A new page will reload that looks like this: The only thing that you need to remember is to list Neishloss & Fleming, Inc. on the Affiliation Line. You will then enter all of your personal information into the requested fields, click Add Me and SureLC will pull your information from the NIPR database. After the data transfer is complete, you will be able to change/update any of the prepopulated information as well as upload a copy of your voided check, proof of E&O insurance, Signature Page and N&F agent addendum (both documents are provided in this pack immediately following this page and must be attached to SureLC). If you do not have access to a scanner, please feel free to use the provided fax cover sheet and fax the forms (as well as a copy of your voided check for EFT) to and we will them to you in PDF format. At the end of this pack you will find a SureLC FAQ containing additional information on the SureLC online contracting process. If you have any questions at all, give us a call at We look forward to working with you!

2 Date: I,, would like to be appointed for Agent Name Avalon Carrier Name through Neishloss & Fleming, Inc. My Commission level for this carrier is Agent. Commission Level Should you have any questions, please call me at. Phone Number Sincerely, Agent Signature **Visit our website ( for additional Carrier contracting requirements, including state appointment fees (if applicable) and Proof of E&O** By signing and electronically submitting this form, I am agreeing to contract for the carrier(s) listed above at the stated commission level with the stated hierarchy.

3 Commission Direct Deposit Authorization 2275 Swallow Hill Road Building 300 Pittsburgh, PA Instructions: Please complete Parts A through C, attach a voided check, and return to address above. Please Print. Part A: Bank Account Holder Personal Information Name / Payee: Street Address: City: State: Zip: Phone Number: Address: Part B: Bank Account Information Action (please indicate): Start Direct Deposit Change Account Information Stop Direct Deposit Account Type (please indicate): Checking Savings Routing Number: Account Number: Part C: Bank Account Holder(s) Signature(s) I (we) give Neishloss & Fleming permission to automatically make commission payments to my (our) bank account. This authorization will remain in force unless I (we) cancel it or my (our) bank account is closed. Signature: Joint Signature: Date: Date: Printed Name(s): / info@neishloss.com

4 Please use this form to designate commission payments from Neishloss & Fleming, Inc. Agent Name: Agency: Address: City: State: Zip: Tax ID: Comments/Instructions: 2275 Swallow Hill Road Building 300 The Bourse Pittsburgh, PA Phone Fax

5 Signature Authorization PLEASE READ THIS AUTHORIZATION, SIGN IN THE BOX BELOW AND SUBMIT THIS FORM BY FOLLOWING THE INSTRUCTIONS PROVIDED ON THE COVER PAGE. I,, hereby authorize SuranceBay, LLC and its general agency customers (the Authorized Parties ) to affix or append a copy of my signature, as set forth below, to any and all required signature fields on forms and agreements of any insurance carrier (a Carrier ) designated by me through the SureLC software or through any other means, including without limitation, by or orally. The Authorized Parties shall be permitted to complete and submit all such forms and agreements on my behalf for the purpose of becoming authorized to sell Carrier insurance products. I hereby release, indemnify and hold harmless the Authorized Parties against any and all claims, demands, losses, damages, and causes of action, including expenses, costs and reasonable attorneys' fees which they may sustain or incur as a result of carrying out the authority granted hereunder. By my signature below, I certify that the information I have submitted to the Authorized Parties is correct to the best of my knowledge and acknowledge that I have read and reviewed the forms and agreements which the Authorized Parties have been authorized to affix my signature. I agree to indemnify and hold any third party harmless from and against any and all claims, demands, losses, damages, and causes of action, including expenses, costs and reasonable attorneys' fees which such third party may incur as a result of its reliance on any form or agreement bearing my signature pursuant to this authorization. Please sign in the center of the box below. Please use BLACK ink. PRODUCERIDXXX

6 TO: COMPANY: Contracting FROM: DATE: FAX NUMBER: RE: TOTAL NO. OF PAGES INCLUDING COVER: Supporting Documentation for SureLC URGENT FOR REVIEW PLEASE COMMENT PLEASE REPLY PLEASE RECYCLE Please find attached my information to complete the SureLC contracting process. I do not have access to a scanner to attach the documents in PDF format. I have included the following documents: N&F Contracting Addendum SureLC Signature Page Proof of E&O Voided Check Supporting Documents for Background Questions Below you will find my contact information in case all documents have not been received as well as to return the forms: Agent Name: Phone Number: Address: S W A L L O W H I L L R O A D, B U I L D I N G 3 0 0, T H E B O U R S E, PIT T S B U R G H, P A V O I C E ( ) F A X ( ) W W W. N E I S H L O S S. C O M

7 SureLC FAQ Do I have to install software onto my computer to use SureLC? No, you do not have to install software to enjoy the benefits of SureLC. You can access SureLC through a web link on the Neishloss & Fleming, Inc. website. How long does it take to set up my SureLC agent profile? You can be set up in SureLC and ready to submit contracting through SureLC in about 8 minutes. Will I be required to complete a new agent profile each time I log into SureLC? No! After you complete your initial agent profile in SureLC, your information will be saved for the next time you want to contract for a carrier. Can I select and submit contracting for multiple carriers at one time using SureLC? You will be able to submit multiple contracts while logged in to SureLC; however you cannot select multiple carrier contracts at one time because SureLC does ask additional questions based upon the carrier selected. How do I electronically sign the contracting forms in SureLC? You have two options for loading your signature into the SureLC website. The first option is to physically sign the Agent Signature document, scan it into your computer, and manually attach the document. The second option is to use your mouse to create an e-signature in the SureLC database. When completing the Agent Profile section of your profile, you will have the option to select the method you wish to use. How do I get a copy of my voided check, E&O, and Signature Page into SureLC? You have a few options of uploading this information into the SureLC database. The first option is to scan and upload a copy of the documents and manually attach them to SureLC. The second option (which is a new feature to SureLC) is to use your computer s webcam and take a picture of the documents. The webcam picture will automatically load the documents into the documents tab of SureLC. If appointment fees are required for a carrier, am I able to pay them through SureLC via credit card? Unfortunately, if an appointment fee is required, you will need to send a check to Neishloss & Fleming, Inc. via USPS as SureLC is not set up to accept fee payment electronically. The fees can be mailed to: Neishloss & Fleming, Inc. Attn: Administrative Division 2275 Swallow Hill Rd. Building 300 Pittsburgh, PA 15220

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