Become a NeitClem Agent

Producer Application & Agreement

All fields marked with * are required. You'll review everything before it's sent. Your information is kept strictly confidential.

Before you begin: You'll accept the NeitClem Producer Agreement at the end of this application. Key terms include premium remittance from your premium trust account only and no flat cancellations once coverage is bound.

Read the full agreement →

01 Agent Information

First Name * First Name is required.

Last Name * Last Name is required.

Email Address * Please enter a valid email address.

Phone Number * Phone Number is required.

Business / DBA Name (if different from your license name)

Mailing Address * Street Address is required.

City is required.

Valid ZIP is required.

02 California Fire & Casualty Broker-Agent License

Name as Appearing on License * Name as appearing on license is required.

License # * License number is required.

Expiration Date * License expiration date is required.

National Producer Number (NPN) (optional)

03 Professional Liability Errors & Omissions

Insurance Company * E&O insurance company is required.

Policy # * E&O policy number is required.

Expiration Date * E&O expiration date is required.

Limits of Liability * Please select your E&O limits.

Limits shown as per claim / aggregate. You may attach your E&O certificate in Section 05.

04 Tax Information

Entity Type * Please select your entity type.

Employer Identification Number (EIN / TIN) * Please enter a valid 9-digit EIN (XX-XXXXXXX).

Please do not enter a Social Security Number. Individual producers without an EIN may leave this blank and attach a completed IRS Form W-9 in Section 05 instead.

05 Supporting Documents (optional)

Attach copies of your broker-agent license, E&O certificate, and W-9 to speed up your review.

Drag & drop files here or browse

PDF, JPG, PNG, WEBP, DOC, DOCX · up to 15 MB each · 10 files / 40 MB max

06 Producer Agreement & Signature

Important Information

You, the Producer and the Insured's designated insurance representative, are responsible for the collection and remittance of all premiums. Premium payments to NeitClem must be from your premium trust account only, except payment from a licensed and authorized premium finance company.
Receiving and/or dispersing premium debits and/or credits is your responsibility, other than exceptions imposed by statute.
Once coverage is bound, there are no flat cancellations.
NeitClem does not communicate with your insureds, except when required by contract or law.
The name of your organization as appearing on your California Fire & Casualty Broker-Agent License must appear on all documents received from you, and only that name.
NeitClem Wholesale Insurance Brokerage, Inc. DBA Xylem Insurance Services is a Fire & Casualty Broker-Agent, Special Lines SL Broker, and Surplus Lines Broker licensed in California, License# 0E24609.
NeitClem adheres to the State of California Insurance Regulations, Rules, and Guidelines — including Fiduciary Responsibilities (Ins. Code §§ 1732, 1733, 1734) and Record Retention (Ins. Code § 1759.3) — and requests that you confirm your compliance as well.

Read the full Producer Agreement

I have read and agree to the NeitClem Producer Agreement, and I confirm my compliance with the State of California Insurance Regulations, Rules, and Guidelines, including Insurance Code §§ 1732–1734 and § 1759.3. I certify that the information provided is true and complete, and that my broker-agent license and E&O coverage are currently active and in force.

Electronic Signature — Full Legal Name * Please type your full legal name to sign.

Date

Typing your name above constitutes your electronic signature on the Producer Agreement.

07 Additional Notes

Notes (optional)

You'll be shown a summary to review before your application is sent.
Typical review time: 1–2 business days. All information is kept strictly confidential.

Why Agents Choose NeitClem

Specialty Markets Access

Fast Underwriting Turnaround

Broker-Focused Support

How It Works

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