Apply for a Broker Account - Complete the Following Form

To apply for a Broker Account please complete the application form below. Once you are finished press "Continue to Confirmation Page".

>> To apply by fax or mail, click here to download the required forms

* = required field

Brokerage Information

Broker Company Name * :
Address Line 1 * :
Address Line 2:
City * :
Province * :
Postal Code * :
Phone Number * :
Fax Number * :
E-mail address * :
Website URL: http://

Principals & CSR Information

Broker Principal(s) * :   Title:   Primary IFS Contact
  Title:   Primary IFS Contact
  Title:   Primary IFS Contact

List of your CSR(s):   E-mail:   Primary IFS Contact
  E-mail:   Primary IFS Contact
  E-mail:   Primary IFS Contact
  E-mail:   Primary IFS Contact

Additional Brokerage Information

Years in business * :    Number of offices * :
Number of employees * :    Number of Producers * :
Average Account Size * : $      Annual Volume * : $
Scope of business:
Commercial / Personal Lines * : Commercial %    /   Personal %
Affiliated with a network? * :   If Yes, Name of network / group:
Specialty Lines / Programs:

Insurer Information

Primary Insurers * :   Contact Name * :
  Contact Name:
  Contact Name:
  Contact Name:

Banking Information

Bank Name and Address * :
Your Account Manager * :
Bank Phone Number * :
Bank Fax Number:

Premium Finance Vendor Information

Current Premium Finance Vendors:    Annual Volume Financed: $
How did you hear about IFS * :

Electronic Payment Distribution System (PDS) - optional

Do you want to apply for PDS at this time? * :   If Yes, complete the following fields in this section.
Payment Notification Method:
Different Fax for PDS:   If Yes, fax number:
Different E-mail for PDS:   If Yes, e-mail address:
Notification sent Attention:
Institution Number:
Branch Number:
Account Number:

How to enter you banking information:

1 - This is the cheque number (do not enter this number)
2 - This is the branch number (5 digit number)
3 - This is the institution number (3 digit number)
4 - This is the account number


Please enter the content of this image in order to confirm you are a real person

© Copyright 2002-2013 IFS Financial Services Inc. Terms of Use | Privacy Statement