User account

Account information

Username: *

Your preferred username; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Password: *

Confirm password: *

Provide a password for the new account in both fields.

About Your Company

What is your current regulatory status?: *

The content of this field is kept private and will not be shown publicly.

If you are an appointed representative, do you have the permission of your principal to deal with 3XD?:

The content of this field is kept private and will not be shown publicly.

How Many Mortgages does your company write each month?: *

How may general insurance policies does your company write each month?: *

Personal Information

Company Name: *

Contact Name: *

Company Address Line 1: *

Company Address Line 2: *

Company Address Line 3:

Company Address Line 4:

Post Code: *

Telephone Number: *

Mobile Phone Number:

Company FSA Number: *

Additional Services From 3XD

Would you like 3XD to prepare statements of demands and needs for you?: *

The content of this field is kept private and will not be shown publicly.

If yes, what level of service do you provide?:

The content of this field is kept private and will not be shown publicly.

Would you like 3XD to always advise you of customer cancellations?: *

The content of this field is kept private and will not be shown publicly.

If yes, how many providers do you use for household insurance?:

If you use 3XD exclusively for household insurance select Limited Number of Providers The content of this field is kept private and will not be shown publicly.

If yes, how many providers do you use for payment protection insurance?:

If you use 3XD exclusively for household insurance select Single Provider The content of this field is kept private and will not be shown publicly.

Banking Details

Bank Name: *

The content of this field is kept private and will not be shown publicly.

Bank Branch: *

The content of this field is kept private and will not be shown publicly.

Account Number: *

The content of this field is kept private and will not be shown publicly.

Sort Code: *

The content of this field is kept private and will not be shown publicly.

Bank Account Name: *

The content of this field is kept private and will not be shown publicly.

Preferred Comm Types: *

Initial Indemnity is either 12 or 6 months commission up front dependent on the insurer.

Declaration

I have read and accepted the intermediary terms & conditions, and I have the neccessary authority to enter into this agreement

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