Omega Insurance Office

Get Appointed

To write workers’ compensation or any type of coverage through Omega Insurance Solutions, Inc. your agency must be contracted with Omega Insurance Solutions, Inc. Fill out the form below to submit your application for consideration for appointment.

Address(Required)
Agency Principal Name(Required)
Name Email Actions
   
Does your agency act as a wholesaler or MGA for any insurance
Omega Insurance Solutions only works with retail insurance agencies. If you are a wholesaler or MGA we must have more information before we can consider. If you want to proceed, please complete this application.
Carrier Name Actions
 
Line of Business Actions
 
How did you hear about Omega?(Required)

License and Legal Information

E & O Expiration Date
Date Agency Established
Is your agency a corporation?
Max. file size: 20 MB.
Max. file size: 20 MB.