Why Choose All Risks: Agent Profile

Areas in bold are required.

Your Name: * Your Email: * Were you referred by an All Risks employee to fill out this profile on our website? *
Yes No

If yes, please state with whom you spoke:

Name of Agency: * Mailing Address: * Street Address: City: * State: * Zip: * Phone Number: * Ext: Fax: * Agency Principal: *

Number of Locations:

# of P&C Employees:

Total Agency Volume: *

Commercial %: *

Personal Lines %: *

Other %: *

Average Account Size:

State Licensed:

Specialized Focus: Target Markets/ Industries: *

Programs: Standard Market Contracts: * $ $ $ % of Business, by Line, in Standard Markets: Commercial:

Commercial Auto:

General Liability:

Workers' Comp:

Professional:

Financial Products:

Specialty Programs:

Personal Lines:

Misc:

Wholesale Market Contracts: *

% of Business, by Line, in Wholesale/Excess Markets:

Commercial:

Commercial Auto:

General Liability:

Workers' Comp:

Professional:

Financial Products:

Specialty Programs:

Personal Lines:

Misc:

E&O Carrier:

Limits: $ Have you ever been cancelled by a Wholesale Market? *
Yes No

If yes, please explain: Have you ever been cancelled by a Finance Company? *
Yes No

If yes, please explain: