New Broker Packet

Thank you for your interest in developing a relationship with Black Gould & Associates.  It is our vision to be the most efficient and cost-effective marketing, commission processing and servicing system available to our agents and brokers.  Above all, we value all of our relationships, and credit our success to the people with whom we do business. 

Please submit the following paperwork by clicking on each of the hyperlinks below, so that we may enter your information into our systems.

• A completed broker licensing questionnaire
• A completed IRS W-9 form
• A signed HIPAA privacy statement
• A completed direct deposit authorization form (along with a copy of a voided check)

Forms

• Broker Licensing Questionnaire
• IRS W-9 Request for Taxpayer ID Number and Certification Form
• HIPAA Privacy Statement
• Direct Deposit Authorization Form
• License Packet (All of the above in one file)