Complete the following form to register for a Victor Flood portal account. You will receive an email within 24 hours containing your username and password.

Agency name     Agency principal  
Mailing address     City
State     Zip code
Physical address     City
State   Zip code
Agency FEIN/TaxID   Agency NPN
Phone number   Agent NPN
Fax number   If you don't know the NPN, visit
Agent email address      
Commission/accounting email address    
E&O carrier       Policy #
Effective Date    [None] Select a Date Delete the Date Policy limits
ACH Deposit of commissions 
Bank name      
ABA or Routing #   

Account #      
ACH sweep for insurance premium  

Bank name    
Account #    
To register additional agents at your firm, fill out the information below: 
Agent Name(s):
License #:
CSR(s) within agency

  I am certified to sell flood insurance.

Your office will receive 19% new business and 17% on renewal commission.



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