Thank you for your interest in becoming a registered TotalEvent Broker. Please provide the following information and download the three required forms as indicated below. Click the Save Changes button when finished.
COMPANY:
Company Name:
Address Line 1:
Address Line 2:
City:
State:  
Zip Code:
Please use physical address as we cannot accept P.O. Box numbers.
Main Phone:
Main Fax:
Website Address:
CONTACT:
First Name:
Last Name:
Contact Address and Primary Address are the same
Address Line 1:
Address Line 2:
City:
State:
   Zip Code:
Phone:
Ext: 
Mobile:
Fax:
E-Mail:
Confirm E-Mail:
Are you licensed in your state of domicile? 
License Number(Corporate/Agency):  
Expiration: 
Has Tokio Marine HCC - Specialty Group (previously known as HCC Specialty)
ever quoted a policy for you before?  
How did you learn about us?
IMPORTANT: Before we can activate your TotalEvent account, we must receive a signed Non-Exclusive Producer Agreement and Producer Questionnaire, a signed Electronic Signature Acceptance Agreement, and a completed IRS Form W-9. These signed documents can either be faxed to 781-994-6001 or scanned and e-mailed to service@TotalEventInsurance.com
Download the Producer Welcome Letter
Download the Non-Exclusive Producer Agreement and Producer Questionnaire
Download the Electronic Signature Acceptance Agreement
Download the IRS Form W-9
Download the ACH Authorization Form
Note: These forms require PDF reader software. Please Click here to download the free Adobe Acrobat Reader.
If you have any questions regarding the TotalEvent system or about becoming a TotalEvent Broker, please contact us by
e-mail at service@TotalEventInsurance.com or by phone at 781-994-6000