Thank you for your interest in partnering with MEMIC.

MEMIC is relentlessly committed to workforce safety and our experts work with employers to eliminate hazards, return injured workers to the workplace, and control claim costs in a conscientious manner.

If your agency would like to be considered for an appointment with MEMIC, please complete and submit the Agency Survey form. DocuSign link is below:

Agency Survey

Once we receive the completed survey, our Underwriting leadership team will review the form and someone will contact you to discuss a potential partnership with MEMIC. 

If you would prefer to fill out the PDF version of the survey, download the form below and, once completed, email to agencyservices@memic.com.

MEMIC is also the Guaranteed Market for the State of Maine so if you are looking to obtain coverage for an employer in Maine only, please complete the Application for Authorization. DocuSign link is below:

Application for Authorization

Once the application is reviewed and the license information is confirmed, your agency will be considered “authorized” to submit Maine business only. Please note that a nonresident Maine license is required for BOTH the producer and the agency.

If you would prefer to fill out the PDF version of the application, download the form below and, once completed, email to agencyservices@memic.com.

If you have any questions about either form, please email agencyservices@memic.com and we will be happy to assist you.

Are you an existing agent looking to submit business to MEMIC?

Please read our Agent Submission Guidelines and send your application by e-mail (preferable), mail or fax:

• submissions@memic.com
• MEMIC, Underwriting Dept. 
• PO Box 11409 
• Portland ME 04104 
• Fax 207-791-3335