NOTICE TO ALL APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any false information, or conceals for the purposes of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime.
DISCLAIMER: Completion of this form constitutes a request for coverage, only, and a quote, if applicable, and is not a statement of contract. The coverage descriptions contained herein only provide a general description of the available coverages and are not a statement of contract. All coverages are subject to all policy provisions and applicable endorsements. Coverages and their availability may vary by state and additional minimum coverage limits may be available in your state.
If you want a copy of your application for your records, please print this page before clicking submit.
MANDATORY INITIAL COMPENSATION DISCLOSURE:
As required by the New York State Insurance Department Pursuant to Regulation 194
As an independent insurance agent or insurance broker Sterling & Sterling, Inc may have access to more than one insurance company to place your coverage. Whether acting as an independent insurance agent or insurance broker we have certain obligations to you as the purchaser and certain obligations to the insurance company as determined by both statutory and case law. If acting as an independent insurance agent we may have authority to obligate the insurance company on your behalf and as a result we may be required to act within the scope of our contractual agreement with the company.
As the purchaser you need to understand that we typically will receive compensation from the insurance company based on the agreement we have with each company. That compensation may vary from company to company and also may be impacted by the volume of business we place with the company, the profitability of that business and other factors.
You may receive information about our compensation on the policy or policies you select and about any policies we have presented to you which you did not select by asking us for the information.
It is our privilege to act on your behalf. Please be sure to let us know if you have any questions.