| Record Letter | ||
(This is a sample copy of the Agent of Record Letter. Please place this wording onto your company or personal letterhead.) |
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| (Date) Attention: All Aviation Insurance Companies Re: Assignment of Exclusive Broker of Record Please recognize Thomas M. Blassie of Insurance Source, Inc./Aircraft Insurance Agency (AIA) 4111 Telegraph Rd., Ste. 200, St. Louis, Missouri 63129 as my exclusive agent/broker of record for all lines of coverage for my Insurance needs. I understand that your company will release a quotation for my insurance to only one agent/broker, and that by signing this letter, I am terminating the ability of any other agent/broker (including my current agent/broker) to obtain a quotation or to bind insurance with your company. This appointment rescinds all previous appointments and the authority contained herein shall remain in force until cancelled in writing by us. Please waive the customary five-day waiting period, as this Agent of Record Letter will not be rescinded. Thank you for your consideration. Sincerely, __________________________________________ Insured's Signature __________________________________________ Print Name/Title and or N# ____________________________________________ Company Name if Applicable Please print on your personal or business letterhead and fax or mail to: Aircraft Insurance Agency 4111 Telegraph Rd. Suite 200 St. Louis, MO 63129 Fax: 314-416-1011 |
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