Agency Bill Invoice Request Client Name(Required)First, Last or CompanyClient Email(Required) Policy(ies)(Required)GL#######; XS########Reason for Invoice?(Required)New PolicyEndorsementAuditOtherPlease explain reason for this invoice(Required)Please provide description of the change(Required)Has the MGA invoice been uploaded to client file and properly titled?(Required)YesNoIs this a quote?(Required)YesNoHas the tax and fee information been provided?(Required)YesNo (If not, please provide this information below)Taxes(Required)e.g., 23Fee(Required)e.g., 23Is this policy financed?(Required)Yes (If yes, make sure that the PFA has been uploaded to the client file)NoHas the Accounting Department approved the new policy not to be paid prior to bind?(Required)YesNoHave the fees for the policy been paid?(Required)YesNoIf not, please provide an explanation(Required)Upload any files if necessaryMax. file size: 100 MB.To whom are we sending the invoice?(Required) First Last Contact Email for Invoicing(Required)