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FLORIDA PRODUCERS ONLY!

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Please only use this page to sign up a New Agency.
If you are an existing MyMGA.com producer and know your Producer ID and Password - Please click here.
Click Here if you are a registered producer and forgot your password

 PRODUCER INFORMATION
*Company Name:
*Contact Name:
*Contact Email:
*Password:
*Verify Password:
*Address:
  Address 2:
*City:
*State:
*Zip Code:
*Phone:
*Fax:
Business Type:
Primary Insurance Co:
License #:
Tax ID:
Operating System:
*How did you hear about us?
How many Personal Line CSRs?
How many Commercial Line CSRs?
How many Total Agency Staff?
Additional Information
i.e. website, years in business, primary markets/carriers, etc.
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