Affirmative Insurance Services, Inc. 150 Harvester Drive, Suite 300 Burr Ridge, IL 60527 Phone: 1-800-333-5530   Billing 1-888-425-2455 Please Call Claims 1-800-255-4687 Please Call Marketing 1-800-333-5530 Marketing Website feedback   Hostmaster Support 1-800-333-5530 x 7100 (outside Chicago) 1-708-233-7100 (Chicago)     If you are interested in writing business for Affirmative or Insura Corp, please contact Marketing. For your convenience, you can download and fill out our application for producer contract by clicking on the link below. Producer Contract Application Account Sweep Withdrawal Form Direct Deposit Of Commissions Form W-9 Form To view this document you will need to have an Adobe Acrobat PDF viewer installed on your computer. If you need the latest version of Adobe Acrobat PDF viewer you can click here to download it Copyright c 2005 This website Copyright © 2005-2006 Affirmative Insurance Services, Inc., all rights reserved. No part of this website may be reproduced without first obtaining written permission from Affirmative Insurance Services, Inc. The Affirmative Insurance Services logo is a federally registered service mark that is the property of Affirmative Underwriting Services, Inc., an affiliate of Affirmative Insurance Services, Inc. The products herein may not be: (1) available in all states, and/or (2) available through this company, or an affiliate company, in all states. Further, these products may be available through an unaffiliated company. This is not a contractual offer, proposal or application for insurance. We cannot guarantee your eligibility with any of the carriers referenced. All products/product features are subject to change without notice.