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MGA Agent Registration


Please fill out the following form.  Once you have completed the form, click the “Submit” button to send your information to M&Z Administration and you will receive an email within 24 hours confirming your username and password. 

Personal Information
First Name
Required
Last Name
Required
Agency Name
Optional
E-Mail Address
Required
ZIP / Postal Code
Required
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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