UNDERGROUND STORAGE TANK (UST) AGENCY PROFILE FORM

UNDERGROUND STORAGE TANK (UST) AGENCY PROFILE FORM
COMMON SENSE MARKETS
Please fill out the information below and return to:

Fax: (979) 776-4787

E-mail: service@anco.com

Common Sense Markets, P.O. Box 4870. Bryan, 7X 77805
AGENCY INFORMATION
Agency Name
Contact
Mailing Address
City
State
Zip
County
Telephone
Format: (000) 000-0000.
Fax
Website address
E-mail Address
Tax ID
Agency License #
E&O Insurance Carrier
E&O Limit
AGENCY LOCATION
Main Location (City/State)
Satellite Offices (City/State)
Single ResidenceApartmentTownhomeCondoStrip MallMulti-Unit OfficeSingle Occupancy Commercial Building
OWNERSHIP
Sole PropietorshipPartnershipCoporationLLC

Name(s) of Owners, Titles, and Years of Experience

Years CL Experience within Agency:
Year Agency Established
Number of years under current ownership
Number of People in these Positions:
Producers/Solicitors
CSR's
Other
CPCUCICAAICLUACSRCISR
YesNo
Please provide name
YesNo
Please provide name:
YesNo
Please provide name:
Automation System(s) used:
Bookkeeping/Rating/ManagementBookkeepingRating Only
UST CARRIERS & PRODUCTION
All RiskACEBurns & WilcoxColonyCrum & FosterFoss HardyMid-ContinentTank Owner MembersTop TanksTudor Insurance Co.USI SouthwestOther
Which Carriers(s) is/are most competitive?

Top 3 UST Carriers:

AGENCY VOLUME:
Total Agency Volume
Percent of Agency Volume is:
CL
PL
Life/Health
UST
How many UST policies do you currently have in your Agency?
Why are you looking for a new carrier(s)?
What New Business commitment can you make?
First Year PIF
2nd Year PIF
3rd Year PIF
SALES & MARKETING
Use Lead Generation ProgramHave re-solicitation programMotivated by Contests/IncentivesUse TelemarketerFocused on Niche programsSell Small Group P&CHave Effective Cross-sell programActively Up-sell customersParnter with Purchasing Groups
What interests you about Common Sense Markets?
ReferralInternetCompetitorClientOther
Should be Empty:

UST CARRIERS & PRODUCTION