Agency Application
Agency Name
*
Agency NPN
*
Please verify here: https://nipr.com/help/look-up-your-npn
Your Name
*
First Name
Last Name
Agent NPN
*
Please verify here: https://nipr.com/help/look-up-your-npn
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address (we are not accepting CA appointments)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
About Your Business
Which states are you licensed to operate in? (Check all that apply)
Arizona
California
Colorado
Connecticut
Washington D.C.
Georgia
Illinois
Indiana
Iowa
Maryland
Massachusetts
Michigan
Missouri
Nevada
New Jersey
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
Tennessee
Texas
Virginia
Wisconsin
Other
Do you focus in any of the below areas? (Check all that apply)
San Francisco - Oakland - San Jose
San Diego
Los Angeles - Orange County
Santa Barbara-San Luis Obispo
Monterey-Salinas
Dallas-Fort Worth
Phoenix - Tucson
Houston
Austin
San Antonio
New York City Metro
Chicago / Cook County
Other areas, not the ones listed.
Which Rater do you use?
*
EZLynx
PL Rater
ITC Turborater
Applied
No Rater
Other
What Rater do you use?
Total NEW homeowners premium written in the last 12 months
*
$ Premium (e.g. $500,000)
On average, how many homes do you quote per month?
*
# of HO quotes per month
How many home policies did you sell last month?
*
# of HO policies sold per month
Please list your average homeowners loss ratio for the past 3 years
*
Loss ratio %
Where do you write most of your home business?
*
Cities (urban)
Burbs (suburban)
Country (rural)
How many producers work in your agency?
*
Please list your top 3 home insurance carriers
*
Carrier Names
Who is your territory manager
*
Name of territory manager
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