Blink IS

Application Form


To link to Blink, please complete the online form if you wish to apply for a Blink Intermediary Solutions agency, which will provide access to a range of insurance products and associated business services.

The process bar above will guide you through the application and should not take more than 5-10 minutes to fully complete.

Alternatively complete up to stage 3 'Branches / Directors' and click on 'Save and Complete'. One of our sales team will then make contact and complete the rest of the application form with you.

The fields in Blue Bold are mandatory.


 Tick to consent to the information you provide in this application being used in the manner set out above.


We would like to keep in touch and provide you with general updates and information on products and services we can provide access to as well as Our general news updates. Rest assured, we will not bombard you with communications and if you change your mind you can opt-out at anytime.

 I am happy to receive communications by email

Please show Our PRIVACY NOTICE to anyone else whose personal information you will be providing to Us (such as employees) and ensure that you have obtained their consent prior to disclosing it.

Continue >