Become a Member - Ohio Insurance Agents

Agency Membership Application Form

Ready to join the OIA community?
Complete the online form to start your agency’s membership application. Our team will follow up personally to guide you through the next steps.

You can also download the application and submit it to OIA’s Membership Experience Manager, Jodie Shaw, at jodie@ohioinsuranceagents.com.

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Agency Information
Agency Name*
Address*
Street Address Address Line 2 City State ZIP Code
Date Agency Established*
MM slash DD slash YYYY
Website
Agency NPN
Total # of Producers*
Estimated Agency Revenue (P&C)*
Estimated Agency Revenue (Life & Health)*
Current E&O Carrier*
E&O Policy Expiration Date*
MM slash DD slash YYYY
Email*
Agency Phone Number*
Agency Fax
Agency Contact
Principal / Main Contact*
First Last
Main Contact's Email*
Main Contact's Phone Number*
Date of Birth*
MM slash DD slash YYYY
Reason for Joining
Referred by (if applicable)
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Have a question about Membership with OIA?

Reach out to our team!

Jodie Shaw, CLCS, CPIA

Director of Business Development
(614) 552-3036
jodie@ohioinsuranceagents.com

Become an OIA Member

Agency Membership Application Form

Agency Information

Agency Contact

Have a question about Membership with OIA?

Reach out to our team!

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