Step 1 Download the Broker Agreement HERE.  Print out and complete the agreement.  Now fax it back to us at:  561-712-5824. 
Step 2 Return to this quick form, complete the fields and click on the submit button.
Step 3 Sit back and relax!  We will be in touch very quickly — usually within one business day — with your Username and Password so you can start using the best add-on programs in the USA!

 

Please give the following information about your agency and needs:
Name  

Agency  
Phone E-mail 

State  
  I'm interested in:  (click all that apply:)
  Towing & Rental Add-on (reimbursement - contract)
 Towing & Rental Add-on 24X7 nationwide dispatch
 AD&D  Rider
AD&D Med Pay & Hospital Indemnity Rider
 Other  (Please specify)

  How did you hear about the T&R Group?        

Please Check all that Apply:

I have downloaded,  completed and faxed back a Broker Agreement. (MANDATORY!) Please issue me a Username and Password so I can begin using your programs!

 I still have questions.  Please have someone call me!

...or call us at now at
     1-800-742-2722!

 

Questions/Comments