Agency Ownership Change - Tuscano Toolbox

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Agency Ownership Change Request

Please complete all fields marked with *

Effective date of change*

Reason for change*

Name of the contact person submitting this request*

Purchased Account Info:

Account #*

Agency Name*

Address Line 1*

Address Line 2

City*

State*

Zip*

Phone*

Fax

New Owner's Info

Does new owner currently have a Tuscano account?*

Tuscano Account # and Agency Name

Agency Name

Address Line 1

Address Line 2

City

State

Zip

Phone

Fax

Plan for the purchased account:

Would you like to keep the purchased account # open and active for new owner?*

Continue to use the same mailing address, phone and fax as entered in the purchased account area above?

Address Line 1*

Address Line 2

City*

State*

Zip*

Phone*

Fax

Billing address same as listed above?

Address Line 1*

Address Line 2

City*

State*

Zip*

Phone*

Fax

Close account and mark all policies to move at renewal to account #

Agency representative you’d like set up (on all policies marked to move) as policy contact

Will the address of the purchased account remain active for you?
No, we're closing the location
Yes, add the above address as branch location on our Tuscano account

Will any purchased agency’s staff remain working for you? If so, list their name and email address

Documentation needed to process the ownership change:

(PDF documents only)

Tuscano ownership change permission letter
(signed but both current and new owner)

Open - Change Permission Letter

Tuscano Agreement

Open Agreement

Open W9

E&O Dec page
(showing limits of $1,000,000 or higher)

Licenses - Agency and Key Staff
(All states you'd like to write business with Tuscano)

Email me a copy of this request