December 11, 2017
Coming Soon!

Forms to Complete

Thank you for your interest in becoming a PIN member.  Before we send you the membership agreement for signing, we will need the following information completed and returned:

1. Completed W-9 Form

2. Copy of your Pennsylvania agency producer license

3. Copy of the agency Errors and Omissions insurance declarations page

4. Completed agency profile page

Please return these items to:

Producers Insurance Network
Attn: Phil Zellers
320 Granite Run Drive
P.O. Box 3320
Lancaster, PA 17604-3320

If you are approved to become a member of Producers Insurance Network, a membership agreement will be sent to you for your signature.  An executed copy will be returned to you for your files.  If you do not qualify to become a member, your membership check will be returned.

Below is a sample membership agreement for your review:

Membership Agreement