Requester:

The Requester MUST be the Agent/Principal/Office Administrator and MUST supply a valid E-mail address for this request to be honored. First time users, please click here for instructions.

Requester Name

Agency Name

Requester E-mail

 

Requested For:

Please complete the information below for up to 20 different accounts. If you have more than one North Pointe Agent Code, please include any additional agency codes in the comments section, making sure to specify which user names(s) each applies to. The login credentials will be shared by the QBE team processing this request.

Name

Agency

SubPro

User Id

User

Agent/CSR E-mail

Code

Type

e.g. John Doe 12345 jdoe15 Customer Rep jdoe@agency.com
1.
 
1 account(s) listed.
 

Comments:

Any questions, concerns, or a request to delete a user from your agency security file can be expressed in the field below.
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