Membership Application | Big I Maryland

Agency Membership Application

APPLY FOR AGENCY MEMBERSHIP

Joining Big I Maryland is simple and will be one of the most beneficial business decisions your agency can make. Please take a moment to go through the eligibility requirements for membership and the details regarding agency dues provided below. Once you've reviewed this information, proceed to complete and submit our online agency membership application below. This simple step will kickstart the membership process and allow you to start utilizing your membership sooner.

Membership Eligibility Requirements

To join Big I Maryland, you must meet the following eligibility requirements:

Actively engaged in the American Agency System. The American Agency System is defined as a system that allows independent insurance agents to locate and sell policies from a large pool of companies
Have one or more Maryland resident licensed agents in the office
Have the legal ability to represent more than one insurance company
Has ownership of agency accounts and policy expirations by contract with insurance companies
Operating on a commission and/or fee basis on his/her own account

Membership Eligibility Requirements

To join Big I Maryland, you must meet the following eligibility requirements:

Actively engaged in the American Agency System. The American Agency System is defined as a system that allows independent insurance agents to locate and sell policies from a large pool of companies
Have one or more Maryland resident licensed agents in the office
Have the legal ability to represent more than one insurance company
Has ownership of agency accounts and policy expirations by contract with insurance companies
Operating on a commission and/or fee basis on his/her own account

Membership Dues

Organization Code

Enter the organizational code provided by your organization.
This connects your account to your organization's Big I Maryland membership.

Membership Type *

Add-On Password

Create a password your employees can use to link their individual accounts to your organization's Big I Maryland membership. Share this password with your team so they can register under your agency.

Contact Information

Email *

Re-enter your email *

First Name *

Last Name *

Suffix

Title

Informal Name

Agency *

Address Line 1 *

Address Line 2

City *

State

Zip Code *

Website

Company Logo

Phone Number *

Fax Number

CC Email

Include me in Membership Directories *
Yes No

Username/Password Username/Password

Please enter the Username/Password you would like to use to login to this website.

Your Username must be unique and must be at least 6 characters.
Passwords must be a minimum of 8 alpha-numeric characters with at least 1 number or 1 letter.

Username *

Password *

Confirm Password *

Additional Information

Year Established *

Total # of Employees *

Revenue - Property & Casualty

Revenue - Life & Health

E&O Carrier *

E&O Expiration Date *

Percentage of Personal Lines *

Percentage of Commercial Lines *

By submitting this application, I confirm that I have read and understand the membership requirements for Big I Maryland. I certify that our agency meets all eligibility criteria and agree to uphold the mission, values, and standards set forth by the association.

Payment Details

Payment Method

Enter the name on the bank account according to the information shown on your bank statement. The account number and routing number can be copied from the lower left corner of the check.

Account Type

Checking

Savings

Routing Number

Account Number

Account Holder Type

Business

Personal

Business Name

Account Holder Name

By submitting payment, I am authorizing Big I Maryland to initiate a single or recurring ACH/electronic debit in the amount indicated from the bank account I designated above. I understand that this Authorization will remain in full force and effect until the transaction is cancelled by me by contacting Big I Maryland, or the ACH/electronic debit is processed from the designated account. I certify that (1) I am authorized to debit the bank account above and (2) the ACH/electronic payment I am authorizing complies with all applicable laws.

Name on Card

Card Number

Expiration

CSC

Billing Street

Billing Zip Code

PO #

Save payment method for future purchases

Due Today

Surcharge

Total Amount Due

Enable Automatic Renewals? *

Select "Yes" to enroll in automatic membership renewal. The payment method submitted with this form will be used for your future membership renewals. You can change the automatic renewal setting or saved payment method at any time in either the "Payment Methods" or "Renewal Settings" where you edit your profile.

Yes

SURCHARGE: Please note, there is a 3% surcharge on all credit card payments and a $2.00 surcharge on all eCheck payments.

Please Note: All membership dues are non-refundable.

If you have questions regarding agency membership, please reach out to our membership team at membership@BigIMD.com.

Agency Membership Application

Membership Dues

Contact Information Contact Information

Username/Password Username/Password

Additional Information Additional Information

Payment Details Payment Details

Contact Information

Additional Information

Payment Details