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ISM Applicationagentsunited2023-08-25T10:36:10-06:00

General Information:

Name

First Last

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Marketing Profile:

Year Established

Total Premium Volum ( Personal & Commercial) $

Mix of Business: Personal Lines %

Commercial Lines %

Other %

Agency Primary Marketing Territories: 1

Agency Primary Marketing Territories: 2

Does Agency have formal perpetuation plan?

Yes

No

If Yes, Explain

Business Structure:

Corporation

Partnership

Individual

Other

Does Agency have a new business prospecting program in place?

Yes

No

Does Agency have a renewal retention/account development program?

Yes

No

Any advertising in place?

Yes

No

Other profit centers in the agency:

Commercial

Life

Bonds

Excess and Surplus

Specialty Lines

Other Business Involvements:

None

Real Estate

Savings & Loan

Banking

Mortgage Loan

Accounting

Life Insurance

Premium Financing

Investment Securities

Other

Is there potential for a book transfer?

Yes

No

Company Name 1:

Company 1 Loss Ratio %

Company Name 2:

Company 2 Loss Ratio %

Company Name 3:

Company 3 Loss Ratio %

Any plans for acquisitions or mergers? (If yes, explain in narrative)

Yes

No

Anticipated agency volume in 3 years $

in 5 years $

Agency Automation:

What functions are automated?

Rate/Quote-Vendor:

Management System:

Version:

Office Profile:

Key Agency Personnel 1:

Title/Position 1:

Yrs w/Agency Yrs. in Ins. 1:

Licensed 1:?

Yes

No

Key Agency Personnel 2:

Title/Position 2:

Yrs w/Agency Yrs. in Ins. 2:

Licensed 2:?

Yes

No

Key Agency Personnel 3:

Title/Position 3:

Yrs w/Agency Yrs. in Ins. 3:

Licensed 3:?

Yes

No

Key Agency Personnel 4:

Title/Position 4:

Yrs w/Agency Yrs. in Ins. 4:

Licensed 4:?

Yes

No

Key Agency Personnel 5:

Title/Position 5:

Yrs w/Agency Yrs. in Ins. 5:

Licensed 5:?

Yes

No

Growth Goals:

Appointment Year:

Appointment Year Goals $:

1st Full Year 20___:

1st Year Goals $:

2nd Full Year 20___:

2nd Year Goals $:

3rd Full Year 20___:

3rd Year Goals $:

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