To become an appointed broker with Mark D. Fredricksen Insurance Services, Inc., you must complete the following before we can quote or bind coverage.  If you have any questions regarding any of the steps, please do not hesitate to call Mark Fredricksen at (800) 699-4347.

Step 1:

Download application PDF to your computer and answer all questions completely.  If a question does not apply, please write "N/A" in the space provided.


Appointment Application

Step 2: 

Email or fax completed application along with a copy of your Errors & Omissions policy, and a copy of your Agency License to, or fax to (951)848-0795