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.

Agency Name(Required)

Street Address(Required)

City(Required)

State(Required)

ZIP Code(Required)

Date Agency Established(Required)

Agency NPN(Required)

Agency Website (if applicable)

Total Number of Producers(Required)

Estimated Agency Revenue (P&C)(Required)

Estimated Agency Revenue (Life & Health)(Required)

Current E&O Carrier(Required)

E&O Policy Expiration Date(Required)

Agent Contact Information

Agency Principal Full Name(Required)

First Last

Agency Principal Email(Required)

Enter Email Confirm Email

Agency Principal Phone(Required)

(###) ###-####

Date of Birth(Required)

Primary Reason for Joining(Required)

Referred by(Required)

Any comments or questions at this time? We want to hear from you!

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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

Agent Contact Information

Have a question about Membership with OIA?

Reach out to our team!

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