New Hire Strategy
New Hire Frequency
Start Date
Assigned Account Manager
Method
Case Name
Split Agreement
Split - Carrier #
Carrier 1
ER Paid %
EE Paid %
Ancillary %
Total % must add to 100
Please, make sure this adds to 100
Carrier 2
ER Paid
EE Paid
Ancillary
SUM Carrier 2
Please, make sure this adds to 100
Carrier 3
ER Paid
EE Paid
Ancillary
SUM Carrier 3
Please, make sure this adds to 100
Carrier 4
ER Paid
EE Paid
Ancillary
SUM Carrier 4
Please, make sure this adds to 100
Commissions Distribution
Number of parties splitting commission
Title 1
Name
ER Paid
EE Paid
Ancillary
Title 2
Name
ER Paid
EE Paid
Ancillary
Title 3
Name
ER Paid
EE Paid
Ancillary
Title 4
Name
ER Paid
EE Paid
Ancillary
Title 5
Name
ER Paid
EE Paid
Ancillary
Title 6
Name
ER Paid
EE Paid
Ancillary
SUM ER Paid
Please, make sure this adds to 100
SUM EE Paid
Please, make sure this adds to 100
SUM Ancillary
Please, make sure this adds to 100
Fees
Application fees
Per Diem
Daily rate
Daily rate - Paid by
Expenses
Expenses - Paid by
Bonus - Paid by
Bonus
Is the broker contracted with Coordination Group?
Yes
No
Technology Build Cost
$
Technology Build Waved?
Yes
No
Button
Email