Electronic Payment Method and Request

Congratulations on your award, incentive, subsidy or prize!

Voluntary Insurance Partners, LLC will send you a 1099 at the beginning of next year for total awards and incentives that total over $600 for the year.

If you have not completed a W-9 specifically for Voluntary Insurance Partners, we ask that you do so. If you have not completed a W-9, Voluntary Insurance Partners, LLC cannot pay you your incentive.

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

VIP Email Address*

jdoe@voluntarypartners.com

W-9 Status*

I have already filled out a W-9 for VIP specifically (not carriers) and I am all setI still need to fill out a W-9

What is this payment for?*

A VIP Contest I wonA subsidy for marketing, software, travel, or office rentVIP Profit Sharing IncentiveOther

Have you set up Direct Deposit with VIP? (This is new for 2025)*

YesNo

VIP's Bank will have to verify your account. This Verification Process typically takes up to 5 business days.

Name on the account for the funds*

Is this a business account or Personal Account?*

Is this a checking or savings account?*

Routing Number:*

Account Number:*

Amount Requested*

Name of the Contest:*

ie: Spring Fever 2023, or Crusin for Cases 2022

What is the subsidy for specifically?*

DON'T CLOSE YOUR BROWSER after Submitting! This will take you to the fillable W-9 form!