BSR Invoice Creation

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Brazos Specialty Risk, Inc.
2113 Greenbriar Drive, Suit D
Southlake, TX 76092
Tel: 877-282-7637

DATE:

Producer

Name of Producer:

Street and Number:

City:

State:

Zip Code:

Insured

Name of Insured:

Street and Number:

City:

State *:

Zip Code:

Invoice Type

Standard

Audit (Agent)

Audit (Insured)

Inspection Unearned Commission

Calculation Settings

Premium

ACCA Dues:

Net Premium

Commission Only Overwrite

Admitted:

Without SL Tax and Stamping Fee

Policy Number *:

Policy Effective:

Expiration Date:

Invoice Date:

Invoice Due Date:
number of days only

Invoice #:

Additional Fee #1:

Additional Fee #2:

Additional Fee #3:

Additional Tax #1:

Additional Tax #2:

Company:

Classification:

Transaction:

Comments/Notices:

Premium *:

Commission, % *:

Overwrite Commission, $ *:

Premium:

Net Premium:

Commission:

Surplus Lines Taxes :

Stamping Fee :

Other Taxes ():

Flat Fee:

Acca Dues:

Additional Fee #1:

Additional Fee #2:

Additional Fee #3:

Additional Tax #1:

Additional Tax #2:

Processing...