RK Hughes and American Modern Insurance Group
Subproducer Profile Order Form
 
Step into American Modern's e-fficient™ world of Web-based services, modernLINK™. Using modernLINK™, you can:
  • View billing and payment data
  • View coverage limits and other policy data
  • View claim status and payments
    		•  
  • View and print policy forms and endorsements
  • View and print applications, rates and more
  • Quote and issue policies online (for selected products)

    • It's easy to sign up for modernLINK™ services. Simply complete the order form below and click Submit. We will process your request and contact you with your modernLINK™ user ID and password.

    Important Information: To establish a profile you must have an IBM compatible PC connected to the Internet through an Internet Service Provider (ISP) and use one of the following browsers: AOL, Internet Explorer 4.0 or higher, or Netscape 4.0 or higher. Non-IBM compatible PC's and/or browsers other than those mentioned above, are not supported at this time. To ensure prompt completion of your profile please complete all items on this form.
    Fields marked with a * are required for submission.
     
    Is this order a NEW request or a CHANGE to an existing profile?    New Profile Order
       Change Existing Profile
     
    Agency Data
    Your Agency Name:  *
    Your 6-Character Subproducer Number(s) 
    with RK Hughes: 
      *
    DBA (if applicable): 
    Street Address:  *
    City:  *
    State:  * Zip:  *
     
    Subproducer Profile Administrator Information
    In the following section, please provide information on the individual who will serve as the Profile Administrator for your agency. This individual will be granted modernLINK™ Security Administration access which will enable him/her to add/modify/delete other users within your agency.
     
    Last Name:  *
    First Name:  *
    E-mail:  *
    Telephone:  ( ) *
    Fax:  ( ) *
    Profile Requested By:  *
    Telephone:  ( )
    Comments: 


         

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    Last Updated on April 6, 2005