Agent Registration - Diversified Agrisurance

Agent Registration

Agent Registration

Welcome to DAC Agent Registration! If you are an authorized DAC agent, please fill out and submit the short form below.
Enter your vital information beginning with your DAC Agency number, your e-mail address and account password.

If you need assistance, please contact Atina Kroh at DAC via e-mail or telephone at 1.800.444.3584

Create a new account

Agency Number

Agency/Agent Name

Agency Contact Name

Agent Email Address

Agency Address Line 1

Agency Address Line 2

Agency City

Agency State

Agency Zip Code

Password

Confirm Password