Crump Referral Form

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1. Submission of this referral form does not waive or amend the terms of my existing producer agreement with Crump, including but not limited to, any licensing and contracting requirements.

2. I acknowledge that Crump may accept or reject the submitted referral in its sole and absolute discretion. Crump shall timely communicate its acceptance or rejection of the referral with me.

3. I acknowledge that if my referral results in a placed and effective insurance policy through Crump, then I will receive total compensation in the amount of fifty percent (50%) of the placed case commissions, payable in accordance with my existing compensation level reflected in Crump’s systems on a single-case basis when I am licensed in the state of sale.

4. In consideration of the payable compensation described above, I waive and relinquish any ownership rights concerning the referral, any policy resulting from the referral and/or entitlement to any other compensation concerning the referral to Crump.

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