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Insurance Agency Invoice Template

Agency-billed premium, policy fees and commission, itemised by policy. Free PDF.

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Most personal lines are direct-billed and never see an agency invoice at all. Commercial accounts are different: the agency bills the premium, collects it and remits to the carrier, and the client's accounts department needs to see which policy each figure belongs to. That is what this document is for, and it is why a single figure marked "insurance" is never enough.

INVOICE Issued
Invoice number:INV-0001
Date of issue:August 2, 2026
Date due:August 16, 2026
Currency:USD
Issued by
Halstead Commercial Insurance
800 Underwriter Plaza
06103 Hartford, CT
United States
accounting@halsteadins.example
Bill to
Kettleman Fabrication Inc.
2200 Foundry Lane
06051 New Britain, CT
United States
ap@kettlemanfab.example
Amount due
$18,626.00
Due in 14 days · Aug 16, 2026
Billing
All three policies above are agency-billed; your workers' compensation policy is direct-billed by the carrier and is not on this invoice. Premium is remitted to the carriers on receipt. The surplus lines tax and stamping fee on the excess layer are statutory and are not refundable pro rata on cancellation.
Description Qty Rate Tax Amount
General liability — annual premium
Carrier: Pinnacle Mutual, policy GL-778412, 12-month term
1$8,450.00—$8,450.00
Commercial property — annual premium
Carrier: Pinnacle Mutual, policy CP-778413, 12-month term
1$6,120.00—$6,120.00
Excess liability — surplus lines premium
Carrier: Meridian Specialty, policy XS-22841, non-admitted
1$3,900.00—$3,900.00
Surplus lines tax and stamping fee
On the excess layer only; not premium and not agency income
1$156.00—$156.00
Subtotal$18,626.00
Total$18,626.00
Amount due $18,626.00
Terms
Net 20 from the effective date. Coverage is subject to the carriers' terms; non-payment may result in cancellation on statutory notice.
Invoice #INV-0001 · Halstead Commercial Insurance · Page 1 of 1

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What to put on a insurance agency invoice

  • Each policy by carrier, policy number and term
  • Premium per policy, since a client with four policies is reconciling four renewal dates
  • Policy fees, inspection fees and surplus lines taxes, which are not premium
  • Endorsements and mid-term changes as their own lines, with effective dates
  • Whether the policy is agency-billed or direct-billed, so nobody pays twice
  • Instalment or finance arrangements, where premium is being financed

Questions

When does an agency invoice a client at all?

On agency-billed business, mostly commercial and surplus lines. Direct-billed policies are invoiced by the carrier and the agency never handles the money — which is exactly why the invoice should say which model each policy is on.

Should commission appear on the invoice?

Not usually on a commission-based placement — the client pays premium, and your compensation comes out of it. Where you charge a broker fee instead of or in addition to commission, that fee must be shown as its own line, because it is the client's money going to you rather than to the carrier.

Why separate taxes and fees from premium?

Because they are not premium and are not refundable the same way. Surplus lines taxes and stamping fees in particular follow their own rules on cancellation, and a client who sees one blended figure will expect a pro-rata refund of the lot.

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