Required Materials

• Application for Premium Service Company, Form 4501
  • Every question on the application must be answered.  Indicate "none" or "not applicable" if a question does not apply.
• Articles of Incorporation or Certificate of Domestication
• License fee of $1,000
• Notice of Financing statement
  • View a sample Notice of Premium Financing statement.
  • The applicant must have a net worth of at least $20,000 and personal assets are not accepted.
• Premium Service Company Bond, Form 4500
  • Under no circumstances will the $50,000 Security Bond or Certificate of Deposit requirement be waived.

The following items must be submitted in duplicate:

• Premium Service Agreement
  • View a sample Premium Service Agreement.
• Maximum Rate Schedule (Form 4503) and Promulgated Maximum Schedule
• Payment book
• Notice of overdue payment (Intent to Cancel)
• Notice to insurer that policy is financed
• Request for cancellation