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New Agent Profile - Commercial Insurance

Welcome! Please complete the below and provide the requested information regarding your commercial capabilities and target accounts.

Agency Name *

Agency Location (City / ST / Zip) *

Company Overview *

Company Website *

Premium Volume (Annual) *

$0 - $1,000,000$1,000,000 - $5,000,000 $5,000,000 - $10,000,000$10,000,000 - $15,000,000$15,000,000 - $25,000,000 $25,000,000 - $50,000,000$50,000,000 - $100,000,000$100,000,000 or higher

How much of your book is commercial (%) *

Target Classes of Business Written *

Target Account / Premium Size ($) *

Direct/Admitted Market Appointments *

Wholesale Brokers/MGA Appointments *

How did you hear about Element22?

Agent Name *

Phone *

Email Address *

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Element22 Insurance Services, Inc.

Home    Commercial Insurance    About Us    Culture/Careers    Contact

3000 Gulf To Bay Boulevard, Suite 600ClearwaterFL33759Phone: (727) 240-3849

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