Sub-Agent Producer Questionnaire
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Agency Information
Agency Name:
Website:
Phone:
Fax:
Address:
City:
State:
Zip:
Type of Business:
Partnership
Sole Proprietorship
Corporation
Year Established
Years at Location:
Office Location:
Residential
Business/Industrial
Type of Office:
Suite
Store Front
House
Office Size:
sq feet
# of Employees:
Tax ID#:
Social Security:
Accounting Contact:
Position:
Phone:
Personnel Experience - Producers & Service
Name
Position
Yrs Experience
Yrs w/ Agency
Email Address
Automation
Agency Management System:
Rating System:
Carrier Interface:
Insurance Carriers
List carriers with whom you actively place business:
List any carrier terminations in the past 3 years and the reason(s) for termination:
Marketing
Primary sources of leads:
Target Markets:
Production
Average number of new accounts written per month (commercial):
Annual Written Premium:
Policy Count:
Association Services and Insurance Brokers, LLC
9171 Towne Centre Drive, Suite 200
San Diego, CA 92122
(800) 420-4678 (858) 597-0830 Fax
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