Agency Call Report

Agency Call Report
Today's Date

Month Day Year
Date
Producer's Name
Producer's Email
example@example.com
Other WWFI Producer's in Attendance
Hold down Shift Key to select multiple names
ALIS CODE
(if known)
WWFI Office
Select your cost center office location.
Check Yes if this is a follow up or continuation report from original submission.

Yes No
Agency Name *
Parent
Telephone
Fax
(000) 000-0000
Street Address
Suite/Floor
City *
State *
ZIP Code
Website
Main Contact *
Title
Direct Phone
Email *
example@example.com
Cell Phone
Lines of Focus
Hold down Shift Key to select multiple lines
Other Wholesaler Relationships:
Other Wholesaler Relationships:
List other wholesalers they are working with.
Wholesaler Expectations
You can use the 3 Genie in a bottle question here (if needed)

Other agency contacts:

Referral/Other Producers

Phone

Specialty

E & S Premium
Total Premium
HIGHLIGHTS / SUBMISSIONS
OBSTACLES (if any)
Other WWFI Brokers they work with?
TO DO ACTION ITEMS:
This week
This month
30-Days
60-Days
90-Days
Continued Agency Notes (add date of edit)
Leadership Email
You do not have to fill this in ... this is for internal form functionality.
Should be Empty: