SUBSCRIBER'S INFORMATION: The Subscriber must provide the information requested below to obtain approval for access to the Electronic Insurance Forms Submission Program, and to obtain a user identification number and password for the Program. Furthermore, the Subscriber must provide the BMV with written notice prior to the Subscriber making any subsequent changes to the information the Subscriber provides in this section.
Note: If you are not a licensed insurance agent, but require access to the EIFS program please click here to request authorization.
Agent's or Broker's Name
Insurance Agency's Name
Business Address
City
State
Zipcode
Phone Number
Email Address
Agent Certification/License Number
License State