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Request Information to Become An ERIE Agent

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Personal Information

Enter a valid First Name
Enter a valid Last Name
Enter a valid email address
Enter a valid phone number
Enter a home street address
Enter a city
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Enter a valid ZIP Code

Professional Information

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*Are you fluent in any languages other than English?

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Select a closest branch
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Are you willing to relocate?

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Please provide community, civic, or professional organizations
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Industry Experience

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License Information

*Do you have an active P&C insurance license

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Select a license state

Agency General Information

Enter an agency name
Enter an agency street address
Enter an agency city
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Enter an agency ZIP Code
Enter an agency phone number
(ex. xxx-xxx-xxxx)
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*Does the agency use a comparative rater?

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*Does agency have locations in other state(s)

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*Does the agency sell life insurance

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Affirmation

I affirm that I have entered truthful and accurate information. I understand that completion of this form does not guarantee or suggest an agency appointment with Erie Insurance and that I am not appointed as an ERIE Agent unless and until I have executed an ERIE Agency Agreement and have been issued an ERIE Agency Number. I further understand that I am solely responsible for evaluating whether to continue to seek appointment with Erie Insurance, including, but not limited to, obtaining appropriate legal and business advice and guidance.

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