 
| RLI
Program Manager
acoelho@massagent.com
Direct: (508) 634-7360
Fax: (508) 634-2930
Toll Free: (800) 742-6363
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New Business Information
Quick Quote
Click "Quick Quote" above to begin your client's application for a preliminary rate and print out the application for completion. Firm pricing is determined on a fully underwritten application. Online submissions are available
via RLI Direct Portal access.
Applications & Forms
No need to submit Dec Pages or MVR's! New Hampshire Clients
NH Primary Resident Current Application NH UM-UIM Rejection Form (PUP 261-0111)
Massachusetts Clients
MA Application & Rate Sheet
MA UM-UIM Purchase or Rejection Form
(PUP 261-0111) Miscellaneous Forms
Auto Endorsement Form Insured Payment Authorization Form
Where to Submit Completed Applications? Secure Submission Portal Upload the insured's completed application and payment authorization form using the submission portal on this page. Angelina will receive securely and no need to mail it to us!
Direct Access to Complete, sign & Pay on the RLI Website
Member Agents may access the RLI website directly. "PUP ACCESS" gives you the ability to submit/quote applications, send to the insured for Review, eSignature and Payment plus gain access to Policy Status, Billing Info, Policy Documents. To obtain "PUP ACCESS" or learn more, contact Angelina Coelho at (508) 634-7360. Mail Submissions
Forward completed RLI applications with a FULL premium check (payable to RLI): RLI c/o Number One Insurance Agency
91 Cedar Street
Milford, MA 01757
Not a Fit with RLI? Try an alternative market Endorsed by IIABA: Anderson & Murison (A&M)
RLI Privacy Policy and disclaimer.
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