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Agent / Agency Information

New Agent Questionnaire  

If you are a surplus lines agent newly licensed in Texas, please complete the following questions concerning your license and submit to SLSOT for processing.  Thank you.

bluebutton Name on Texas surplus lines license:
bluebutton DBA name (trade name(s) approved by the Texas Department of Insurance):
bluebutton Surplus lines license number:
bluebutton License expiration date:
00/00/0000
bluebutton What is the correct address for your agency? Please provide physical and P.O. Box if you use both.
Physical address:  

P.O. Box :  
bluebutton To which address would you like us to forward normal USPS mail to? Physical Post Office Box

Note: Any larger packages will be sent to physical address
bluebutton Primary Stamping Office contact name:
bluebutton

What is your area code and phone number?

  xxx-xxx-xxxxx
bluebutton What is your area code
and fax number? 
xxx-xxx-xxxx
bluebutton What is your website address?   www.
bluebutton

You can locate SLSOT monthly bulletins and the quarterly Lone Star Lines newsletters through our website at www.slsot.org.
If you or others in your office would like to receive e-mail notifications when a bulletin or newsletter has been published to the website, please fill in name and e-mail information in the spaces provided.
(Note: It is the individual's responsibility to notify SLSOT of any e-mail changes that may occur on these personal e-mail boxes.)

(1) Name:             
E-mail address:  

(2) Name:             
E-mail address:  

(3) Name:             
E-mail address:  

(4) Name:             
E-mail address:  

(5) Name:             
E-mail address:  



Please click once on  the "Submit" button below to send to SLSOT for processing. If you have any questions regarding this form, please call (800) 449-6394, ext. 228.






























































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