Guidelines For Agent Appointment/Cancellation
& Website Access

Do you have a new agent or does someone in your office require access to our website?
The forms provided here will allow you to securely send us confidential information and e-signatures. After you complete a form, you will receive a confirmation e-mail (if you do not see the e-mail in your inbox, check your junk/spam folder).
YOU MUST click on the link you are emailed to confirm form submission or we WILL NOT receive your completed form(s).

Licensed Agents:

Appointment and issuance of website credentials: In order to advise policyholders or sign an application for coverage with Loudoun Mutual, the agent must have an active VA Property & Casualty Agent’s License or a Non-Resident VA license and be appointed with Loudoun Mutual. It takes approximately three days to process your appointment once the form has been submitted.

Non-Agent Website Access:

Request for Agent Appointment and Criminal Background Questionnaire

Request for Non-Agent Website Credentials

Request for Appointment Cancellation or Deactivation of Website Credentials

If you need assistance using these forms, please call us or send an email to