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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.

Appointment Application
Agency Address
City
State/Province
Zip/Postal
Country

Other Agency Contacts

Carriers or MGA's Used (Add up to 5)

Does your agency act as a wholesaler or MGA for any insurance?

Omega Insurance Solutions only works with retail insurance agencies. If you are act as a wholesaler or MGA we must have more information before we can consider. If you want to proceed, please complete this application.

Lines of Business

License and Legal Information

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Maximum upload size: 516MB
Drop a file here or click to upload Choose File
Maximum upload size: 516MB
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