I have appointed the new independent broker listed below as my exclusive insurance representative with respect to my health coverage. I have authorized this broker to act on my behalf in place of my former broker, and I rescind all previous appointments. This letter enables you to furnish my new broker with all information he may request as it pertains to my insurance contract. I understand that their broker commission will be paid out of my monthly premiums. This designation will remain in effect until I notify you otherwise, in writing. My Broker of Record is hereby vested with the authority to make any representations, agreements, or promises that are necessary or desirable to arrange insurance on our behalf.
The Credicott Agency