• 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

  • Format: (000) 000-0000.

  • AGENCY LOCATION

  • Agency location:

  • OWNERSHIP

  • Type of Ownership:
  • Type a question
    Rows

  • Number of people in these Positions: 

  • Check all Designations held within agency:
  • Does the agency have ownership in another agency?
  • Does the agency have ownership in captive?
  • Is the agency a member of an aggregator, cluster, alliance, etc?
  • Agency is automated for the following functions:

  • CARRIERS & PRODUCTION

  • Check carriers you have or have had in the past:

  • Approximatly what percentage is Surplus Lines?

  • What New Business commitment can you make?

  • Top 3 Personal Lines Carriers
    Rows
  • Top 3 Commercial Lines Carriers
    Rows

  • Percentage of Volume is:

  • SALES & MARKETING

  • Check the following that apply to your Agency:

  • ADDITIONAL INFORMATION

  • How did you hear about Common Sense Markets?
  •  
  • Should be Empty: