Become an AgentPlease enable JavaScript in your browser to complete this form.Now Appointing Florida Agents - Step 1 of 2Agency Name *Agency Principal Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWebsite / URL *Email *Phone *Top 3 Auto Carriers/MGA's1st Auto Company Name *1st Auto Company Premium Volume *Loss Ratio % Company 1 Selected Value: 0 2nd Auto Company Name *2nd Auto Company Premium Volume *Loss Ratio % Company 2 Selected Value: 0 3rd Auto Company Name *3rd Auto Company Premium Volume *Loss Ratio % Company 3 Selected Value: 0 NextWhich Comparative Rater Do You Use? *TurboRater (ITC/Zywave)EZLynxPL RaterNone/OtherHow Long Have You Been in Business? *Less Than 5 YearsMore Than 5 YearsHave you ever had an appointment terminated for a reason other than production? *NoYesDoes Your Agency Buy Leads/Calls/Clicks? *NoYesHow Many Producers Does Your Agency Employ? *1-56-1010+What Percentage of Your Auto Business is Non-Standard or Minimum Limits? *Less Than 50%More Than 50%How Many Non-Standard Auto Policies Do Write Per Month? *0-100100-250250-500500+How is Most of Your Auto Business Written? *In Office (Walk In)Over The PhoneWhat Percentage of Your Auto Business is Written Outside Your Home County? *Less Than 25%More Than 25%What Percentage of Your Auto Business is Signed Electronically (E-Sign) *Less Than 75%More Than 75%Do You Write Auto Insurance in More Than One State? *NoYesPreviousSubmit
