(FOR
BUSINESS PLACE THE LETTER ON YOUR LETTER HEAD
--OR--
FOR INDIVIDUALS PLEASE ENTER
NAME
ADDRESS
CITY, STATE. ZIP)
(DATE)
RE: Appointment of Lebherz Insurance Agency, Inc. as our Agent/Broker of Record
To Whom it May Concern:
This will confirm that we have appointed Lebherz Insurance Agency, Inc. as our exclusive
insurance agent/broker of record for the following policies
1.
(COMPANY) - Policy #:
2. (COMPANY) - Policy #:
3. (COMPANY) - Policy #:
The
appointment of Lebherz Insurance Agency, Inc. rescinds all previous appointments
and the authority contained herein shall remain in force until
canceled by us in writing.
This letter also constitutes your authority to furnish Lebherz Insurance Agency, Inc.’s
representative with all information they may request as it pertains to our
insurance contracts, rates, reserves, retention, and all other financial data
they may wish to obtain for their study of our present and future requirements
in connection with our insurance policies.
Sincerely,
(NAME)
(COMPANY / INDIVIDUAL NAME)
(TITLE, IF APPLICABLE)
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