PartnerPro Request

Financial Professional Attestation
1. Submission of this referral form does not waive or amend the terms of my existing producer agreement with Rohrer & Assoc., including but not limited to, any licensing and contracting requirements.
2. I acknowledge that I must be licensed in the state of sale, appointed with the carrier the business is being submitted with and have current E&O coverage.
3. I acknowledge that Rohrer & Assoc. may accept or reject the submitted referral in its sole and absolute discretion. Rohrer & Assoc. shall timely communicate its acceptance or rejection of the referral with me.
4. I acknowledge that if my referral results in a placed and effective insurance policy through Rohrer & Assoc., then I will receive total compensation in the amount of fifty percent (50%) of the placed case commissions payable in accordance with my existing compensation level reflected in Rohrer & Assoc.’s systems on a single-case basis when I am licensed in the state of sale.
5. In consideration of the payable compensation described above, I waive and relinquish any ownership rights concerning the referral, any policy resulting from the referral and/or entitlement to any other compensation concerning the referral to Rohrer & Assoc.

Rohrer & Assoc. PartnerPro program is not a means to circumvent any insurance license or carrier appointment requirements. Not all PartnerPro requests will be accepted.
For Financial Professional Use Only. Not intended for use in solicitation of sales to the public. Not intended to recommend the use of any product or strategy for any
particular client or class of clients. For use with non registered products only. Products and programs offered through Rohrer & Assoc. are not approved for use in all states.
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