Additional Agency Information
Years in Business
Have there been changes in Ownership?
If Yes, When (Year)?
Prior Agency Name?
Number of Licensed L&H Producers
Number of Licensed P&C Producers
Number of Personal Lines CSRs
Number of Commercial Lines CSRs
Has Agency Ever Represented Bankers?
If Yes, Provide Producer Code
Overall Premium Size of Agency
Any account current or unearned commission balances past due to any company?
Any judgements or suits against Agency?
Has any carrier terminated the Agency in the past 3 years for production and/or adverse loss ratio?
Have you or anyone in your Agency ever been convicted of a felony crime in any state or federal court?
Any license suspensions in the past 5 years?
Any other business (e.g. real estate) conducted from premises?
Is the agency affiliated with a national or regional brokerage firm?
Please explain any "YES" answers from the above questions.