Policy, Billing, Claim Status

Agency Access Form

Please note: Agency name must read the same as the Louisiana State Property & Casualty License. If none, please enter NONE.

Agency Administrator Information

This email address will be used as the email address associated with the user who is responsible for setting up system users, deactivating users, and resetting password for agency staff.

Please verify that this is a valid email address. Most of Louisiana Citizen's e-mail correspondence will go to this email address.

Agency Mailing Address

Agency Physical Address

Agency Contact Information

Agency Principal Information

Example: Owner, Office Manager, Principal Contact

Agency Company Affiliation Information

Company Affiliate

Regulation 87

This Agreement shall be governed by and construed in accordance with the laws of Louisiana. Any action brought by either party to enforce this Agreement shall be brought in East Baton Rouge Parish, Louisiana. If for any reason a court of competent jurisdiction shall find any provision of this Agreement to be unenforceable, the remaining provisions of the Agreement shall continue in full force and effect.

LCPIC reserves the right to terminate this Agreement and Producers', including its Representatives, right to bind coverage on behalf of LCPIC immediately if the Producer or its Representatives fail to comply with the terms of this Agreement, including, but not limited to, the standards, guidelines and requirements established by LCPIC, as well as the requirements of Regulation 87 in Title 37 of the Louisiana Administrative Code and the Louisiana Revised Statutes.

By typing in your first and last name, you agree to the terms above.
After the form has been submitted, and before your registration can be completed.  The following documents must be emailed or faxed to the Agent Administration Department.
Please email the following documents to  Policy Admin or Fax to (504) 831-6676.
  • Completed W-9 Form
  • Agency Property and Casualty License
  • E&O Coverage Certificate
Registration will not be complete until these documents have been received. 

Please Note:  These documents are for the Agency and do not need to be submitted for each individual producer.