Agent Application

HOW DID YOU HEAR ABOUT SURUS?

AGENT NAME:

First NameLast Name

ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

EMAIL:

example@example.com

BEST CONTACT NUMBER:

Format: (000) 000-0000.

NUMBER OF SALES EMPLOYEES:

NUMBER OF SERVICE EMPLOYEES:

NUMBER OF LAPSE CAN GOAL:

NUMBER OF CURRENT LAPSE CAN:

% OF COMM. BUSINESS:

% OF PERSONAL BUSINESS:

NUMBER OF YEARS AS AN AGENCY:

INBOUND CALLS:

Bilingual assistance:

IN OFFICE TEAM:

VISION/GOALS:

Surus takes ownership of SERVICE action items.

Surus alone begins and completes each service action item.

Surus is the liaison connecting, coordinating, & communicating onbehalf of the agency and the client.

AVERAGE DAILY ACTION ITEMS :

How are you working Increases now and why?

Is your agency in policy center and SF Billing, if so to what capacity?

Are you interested in MOD training?

Claims process:

Once a task has been created for an email in shared folders:

AGENT INTRODUCTION