The following information will help us best serve your needs and assign an associate.
Name *
Company Name *
Number of Employees
Years in Business
Phone *
Email *
Location
Yearly BOB Gross Commissions
Retention Ratio
Loss Ratio
Auto 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Workers' Comp 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
General Liability 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Standard BOB 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Homeowners 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Non Standard BOB 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Private lines 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Surplus Lines 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Commercial Lines 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
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