JJFL Broker Access

Complete the below form so we have up to date information about your agency.

Agency Name

Owners Name:

Filing Tax Option

Corporation-FEIN

Social Security #

Are You Filing Your Taxes as a Corporation or an Individual Agent: Provide Your FEIN or SSN:

First Name

Last Name

Primary E-mail

Secondary E-mail

Additional E-mail

Office Phone Number

ext.

Office Fax Number

Mailing Address
Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Physical Address (Check to use Mailing Information: )
Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Choose a password to use in order to access this system.
Password:

Upload Proof of Your Current E&O and W9 Forms: See note below. Note PDF or Word Doc accepted only

Miscellaneous Space for Your Comments

You can also submit documents to JJFL via Fax: 201-947-1017. Thank You.