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.

• To request appointment:
• All agents MUST review these Administrative Letters: http://www.scc.virginia.gov/boi/adminlets/allagents.aspx.
• Submit the Request for Agent Appointment and Criminal Background Questionnaire form (also located at the bottom of this page) you are required to attach a copy of the agent's VA Property & Casualty license to the form.
• To cancel an appointment for an agent that has left your agency, simply fill out the Request for Appointment Cancellation or Deactivation of Website Credentials form (also located at the bottom of this page).

Non-Agent Website Access:

• To request website credentials for agency staff who are not licensed but require website access to post payments or provide general account servicing, please submit the Request for Non-Agent Website Credentials form (also located at the bottom of this page).
• To cancel or terminate website credentials for an unlicensed user simply fill out the Request for Appointment Cancellation or Deactivation of Website Credentials form (also located at the bottom of this page).

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 support@loudounmutual.com.