AGENCY PROFILE FORM

AGENCY PROFILE FORM

COMMON SENSE MARKET
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
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)
Agency location:

Single ResidenceApartmentTownhomeCondoStrip MallMulti-Unit OfficeSingle Occupancy Commercial Building
OWNERSHIP
Type of Ownership:

Sole ProprietorshipPartnershipCorporationLLC

Type a question

Years of Experience within Agency:
Year Agency Established:
Number of Years under current Ownership:
Number of people in these Positions:
Producer/Solicitors
CSR's
Other
Check all Designations held within agency:

CPCUCICAAICLUACSRCISR
Does the agency have ownership in another agency?

YesNo
Please provide name
Does the agency have ownership in captive?

YesNo
Please provide name
Is the agency a member of an aggregator, cluster, alliance, etc?

YesNo
Please provide name
Automation System(s) used:
Agency is automated for the following functions:

Bookkeeping/Rating/ManagementBookkeepingRating Only
CARRIERS & PRODUCTION
Check carriers you have or have had in the past:

ChubbThe HartfordMetLifeMid-ContinentRepublicSafecoTravelersOther
Approximatly what percentage is Surplus Lines?
Commercial:
Personal:
Which Carriers(s) is/are most competitive?
Why are you looking for a new Carrier/Broker?
What New Business commitment can you make?
1st Year: PIF
1st Year: PL
1st Year: CL
2nd Year: PIF
2nd Year: PL
2nd Year: CL
3rd Year: PIF
3rd Year: PL
3rd Year: CL

Top 3 Personal Lines Carriers

Top 3 Commercial Lines Carriers

Total Agency Volume:
Percentage of Volume is:
CL
PL
Life/Health
SALES & MARKETING
Check the following that apply to your Agency:

Use Lead Generation programUse TelemarketerHave Effective Cross-sell programHave Re-solicitation programFocused on Niche programsActively Up-sell customersMotivated by Contest/IncentivesSell Small Group P&CPartner with Purchasing Groups
ADDITIONAL INFORMATION
What interests you about Common Sense Markets?
How did you hear about Common Sense Markets?

ReferralInternetCompetitorClientOther
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