Agent Appointment
BGA Licensing Information Form

License Information

Copy of License(s)

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Commission Information

In order for commission to be paid the following EFT information must be completed. Commissions are deposited every Monday for balances over $5.
Commissions can only be paid to the entity that holds the license.
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DO NOT submit a deposit slip
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Carrier/Products Information

Note: we market additional carriers that do not require broker contracting.
Black, Gould & Associates, Inc. ("BGA") endeavors to maintain a culture of integrity and trust among our agent partners, employees, officers, and directors so as to reflect our values throughout our business actions. In order to provide our customers with a broad range of products and services as effectively and conveniently as possible, we use technology to manage and maintain customer information. The following policy serves as a standard for all BGA employees for collection, use, retention, and security of nonpublic personal information.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
You will be contacted by BGA with a one-time, temporary password. You will be able to create your own password upon login.
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