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New Agency Appointment Request
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Questionnaire:
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Agency Appointment Type:
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Date Established:
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Has any insurance company cancelled its connection with your agency in the last three years? (if yes, explain)
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Please enter the reason for the cancellation.
Top three Carrier Profiles for your agency:
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2) Carrier Name:
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% Commercial:
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3) Carrier Name:
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% Commercial:
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What is your total agency premium?
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Would business with Donegal be primarily:
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Do you accept brokerage business?
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What is your potential Donegal volume for the 1st year?
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Are you currently part of an agency cluster organization?
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Please enter the name of the Agency Cluster.
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Why are you interested in an appointment with our Insurance Company?
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