Inquiry Application

Name of Inquirer:

Name of Agency/Entity:

Address:

State/Province:

Country:

Telephone Number:

Facsimile Number:

Email address:

Website address:

What product or products does your company provide? Life, health, disability, property and casualty, marine, human resources, financial guarantees, surety and performance bonds, agribusiness, export/import, general liability and umbrellas, art/jewelry, intellectual property, other:

What industries do you work with? Agricultural, health care, construction, professionals, marine, financial, import/export, manufacturing, utilities, transportation/logistics, technology, mining/natural resources, telecommunication, entertainment, hospitality, aviation/aerospace,other:

What type of insurance product(s) are you interested in?

What kind of sales volume premium does your company do annually?

How many agents do you contract with?

What geographic area do you cover?

Do you have a present need for insurance products?

If yes, which product(s)