Agency Transfer Request

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Important Notice:

This form is no longer monitored. If you wish to sign up with a new NEXT Insurance partner, you are welcome to do so.

If you are experiencing issues with your account or need to terminate your relationship with a NEXT partner, please email us us at appointments@nextinsurance.com.

Be sure to include your full name and email address in your message.

Please do not submit any information through this form, as submissions are no longer reviewed.

First Name *

Last Name *

Phone number *

Who is your current NEXT Partner?
*

I am directly appointed with NEXT

Agentero

AmWins

Appalachian Underwriters

Bass Underwriters

Bold Penguin

Bolt Access

Eastern Underwriting Managers

First Connect

JE Brown

London Underwriters

NBS/Nationwide

Scottish American

Simon Agency

USG Insurance Services, Inc.

I don't know

Other:

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